A Retrospective Analysis of Fertility in Female Patients with Advanced Stages of Hodgkin Lymphoma Treated with BEACOPP Escalated Chemotherapy (25 Year Experience of a Single Centre)
On behalf of Czech Hodgkin Lymphoma Study Group The authors declared no potential conflicts of interest.
BEACOPP escalated (eBEA) includes alkylating agents and its gonadal toxicity has been reported in prospective and retrospective studies. This retrospective study analyzed fertility of 119 young female patients (pts) with initial diagnosis of Hodgkin lymphoma (HL) in advanced stages treated with eBEA.
Patients and Methods:
Overall 128 women aged 18-34 years (median age at diagnosis was 27 years) were treated with eBEA between 1997 and 2020. Median follow-up since the beginning of the treatment was 12.4 years. Overall 57 pts (48%) received 8 cycles of eBEA, 46 pts (39%) were treated wit 6 cycles and 16 pts (13%) received 4 cycles of eBEA. Additional radiotherapy was indicated in 36 pts (30%). Gonadotropin-releasing hormone-analogue Gosereline acetat received 68 pts (57%) and 51(43%) pts used oral contraceptives during chemotherapy to prevent gonadal toxicity. Median follow-up after the end of treatment was 12 years.
Out of 119 women 45 (38%) delivered 61 babies including 18 (40%) women with 2 deliveries after treatment with eBEA. Number of all delivered healthy babies was 59 (one baby was born with small cleft lip, other with mild renal malformation). Two pregnancies were terminated prematurely (week 20 and 22) due to congenital malformations: monozomy 45, X0 Turner syndrome and serious cleft lip). All pregnancies were spontaneous except of 6 women that underwent in vitro fertilisation (IVF) Median time from the end of terapy until the delivery of the first baby was 66 months (range 18-169m). 40 children (65%) were born in the group of pts aged 18 - 24 years, 16 (26%) in the group of 25 - 29 years and only 5 (9%) in the group of 30 - 34 years.
Our data indicate that even after eBEA 38% of young fertile women in advanced stages of HL are able to deliver babies and protection of fertility should be offered to them. Implementation of new strategies with reduction of chemotherapy cycles based on PET may further contribute to fertility preservation.