Newer Hodgkin Lymphoma Regimens Are Less Toxic, But Still Impose Reproductive Risks
A substudy of a multinational study sought to determine the risk to ovarian function with ABVD, AVD, and BEACOPP regimens on ovarian function in women with Hodgkin lymphoma.
Modern chemotherapy treatments for Hodgkin lymphoma are generally less toxic to a woman's reproductive system than older treatments are, but they still pose a reproductive risk for women, particularly those older than 35, according to a published study in The Lancet Oncology.
As part of a larger multinational study on therapy for advanced Hodgkin lymphoma, this prospective substudy involved 67 female patients evaluated before, during, and after chemotherapy for ovarian function by measurement of both antimüllerian hormone (AMH) and follicle-stimulating hormone (FSH) levels in one of two groups. One included patients who received doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD [n=24]) or ABVD minus bleomycin (AVD [n=33]). The other group featured patients who required bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisolone (BEACOPP [n=10]). Additional patients were assessed for FSH levels following chemotherapy treatment (ABVD [n=142], AVD [n=140], BEACOPP [n=39]).
Antimüllerian hormone decreased across treatment groups, but recovery showed age- and treatment-related effects, with ABVD-AVD groups showing 1-year recovery to a median 10.5 pmol/L (IQR 4.3-17.3) serum AMH, while patients on BEACOPP held at a median 0.11 pmol/L (IQR 0.07-0.20) serum AMH. Among patients younger than 35 at diagnosis, ABVD-AVD therapy had little effect on ovarian recovery (mean 127% of AMH vs baseline), but an age-associated impact on ovarian recovery was detectable (mean 37% AMH of baseline, P <.0001 for age comparison) in women 35 or older. This appeared to be independent of a natural decline in ovarian function with age. Follicle-stimulating hormone also showed age-related effects for ABVD-AVD patients. With BEACOPP, however, patients of all ages showed negative consequences for recovery of ovarian function.
The researchers cautioned that effects on reproductive function and fertility preservation should be discussed with female patients approaching treatment with ABVD-AVD or BEACOPP and with regard to age where appropriate.
Anderson RA, Remedios R, Kirkwood AA, et al. Determinants of ovarian function after response-adapted therapy in patients with advanced Hodgkin's lymphoma (RATHL): a secondary analysis of a randomised phase 3 trial [published online September 13, 2018]. Lancet Oncol. doi: 10.1016/S1470-2045(18)30500-X