Risk of premature menopause after Hodgkin lymphoma treatment is mapped

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Women treated for Hodgkin lymphoma will be able to better understand their risks of future infertility after researchers estimated their risk of premature menopause with different treatments.

The findings, published in the Journal of the National Cancer Institute (2014; doi:10.1093/jnci/dju207), are based on the experiences of more than 2,000 young women in England and Wales treated for the cancer over a period of more than 40 years.

Previous research has suggested that women with Hodgkin lymphoma who receive certain types of chemotherapy or radiotherapy are at increased risk of early menopause, but information was insufficient to provide patients with detailed advice.

But the new study, led by scientists at The Institute of Cancer Research (ICR), London, United Kingdom, provides precise estimates of risk for women depending on which treatment types and doses they received and at what age. This will allow doctors to give them detailed advice about their risks for future infertility.

The research team followed up 2,127 women who had been treated for Hodgkin lymphoma in England and Wales between 1960 and 2004, and who were younger than 36 years at the time. All had received treatment with chest radiotherapy, sometimes alongside other treatments.

Some 605 of the women in the study underwent nonsurgical menopause before age 40 years. This was a large enough number for the researchers to estimate accurate risks of menopause at different ages, depending on the mixture and doses of treatments they received and their age when they received them.

The researchers produced a risk table that could help improve the advice that clinicians can give to women who have undergone treatment for the Hodgkin lymphoma. Several of the treatments caused a sharp increase in premature menopause risk.

For example, a woman who received treatment in her late 20s of six or more cycles of a standard chemotherapy regimen without radiotherapy to the pelvic area had an approximately 18% chance of undergoing menopause by age 30 years, or 58% by age 40 years.

Overall, risk of premature menopause was increased more than 20-fold after ovarian radiotherapy, and also after some specific chemotherapy regimens. Risk of menopause by age 40 years was 81% after receiving ovarian radiotherapy at an overall dose of 5 Gray or more, and up to 75% after chemotherapy, depending on the type; however, the risk was only 1% after receiving the chemotherapy regimen ABVD.

"We hope our study will help women to understand better, in consultation with their doctors, their risks of future infertility following treatment for this malignancy. By looking in a much larger group of women than previous studies of this type, we were able to produce age and treatment specific risk estimates that we hope will be of practical use to individual women," said study leader Professor Anthony Swerdlow, Professor of Epidemiology at ICR.

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