Background: Reproduction in classical Hodgkin lymphoma (cHL) survivors has been shown to be reduced compared to the general population, likely due to multi-agent chemotherapy. Understanding if contemporary treatment protocols are associated with reduced reproduction is important as treatment guidelines shift towards more liberal use of more intensive chemotherapy.
Methods: We identified 2,937 individuals aged 18-40 years with cHL in Swedish and Danish lymphoma registers, and in the clinical database at Oslo University Hospital (OUH) between 1995 and 2019, who were linked to national medical birth registers in each country. Cox regression adjusted for stage, performance status, year and age at diagnosis was used to estimate hazard ratios (HRs) contrasting time to first childbirth by treatment groups (ABVD, 2-4 BEACOPP, 6-8 BEACOPP) up to ten years after diagnosis. Cause-specific cumulative incidence (CIF) of childbirths was further estimated using flexible parametric survival models. All analyses included an interaction between cHL treatment and sex.
Results: Overall, 71.4% of patients were treated with ABVD, 3.6% with 2-4 BEACOPP, and 10.3% with 6-8 BEACOPP. The reproduction rates (per 1,000 person-years) were 45.5 (males) and 48.2 (females) in the ABVD group, and 23.8 (males) and 39.9 (females) in the 6-8 BEACOPP group. The adjusted HR comparing reproduction rates in individuals treated with 6-8 BEACOPP to ABVD was 0.51 (95% CI 0.35-0.73) for males and 0.82 (95% CI 0.57-1.19) for females. The CIF after 10 years was 20.0% (CI: 14.7%-27.2%) for males and 33.0% (CI: 24.6%-44.3%) for females treated with 6-8 BEACOPP.
Conclusion: We found that BEACOPP treatment is associated with decreased reproduction rates compared to ABVD in male cHL patients. Infertility counselling should be prioritized for this group.
This abstract has been accepted and presented at the EHA 2022 congress.
Joshua P. Entrop, Caroline E. Weibull, Karin E. Smedby, Lasse Hjort Jakobsen, Andreas K. Øvlisen, Daniel Molin, Ingrid Glimelius, Anna Marklund, Harald Holte, Alexander Fosså, Knut B. Smeland, Tarec Christoffer El-Galaly, Sandra Eloranta