Swedish Study Indicates No Pregnancy-Related Increase in Risk of Relapse in Hodgkin Lymphoma


Key Points

  • Pregnancy was not associated with an increased risk of Hodgkin lymphoma relapse in women with Hodgkin lymphoma in remission.
  • The standardized incidence ratio for women with vs without a recent pregnancy was 0.27.

In a Swedish study reported in the Journal of Clinical Oncology, Weibull et al found that pregnancy did not appear to increase the risk of subsequent relapse in women with Hodgkin lymphoma in remission.

Study Details

The study included data from Swedish health-care registers and medical records on 449 women who were diagnosed with Hodgkin lymphoma between 1992 and 2009 at ages 18 to 40 years. Follow-up started 6 months after diagnosis, when patients were assumed to be in remission; follow-up ended with the first date of relapse, death, emigration, or on December, 31, 2010. Pregnancy-associated relapse was defined as relapse during pregnancy or within 5 years after delivery.

No Increased Risk

Among the 449 women, 144 (32%) became pregnant during follow-up; 178 (40%) were nulliparous throughout follow-up, and 127 (28%) were parous but had no pregnancies during follow-up. Overall, 47 relapses were identified, with 1 considered a pregnancy-associated relapse; the 46 nonpregnancy associated relapses occurred over 2,481 person-years of follow-up, and the 1 pregnancy-associated relapse occurred over 627 person-years of follow-up.

The adjusted hazard ratio (HR) for pregnancy-associated relapse rate vs nonpregnancy-associated relapse rate was 0.29 (95% confidence interval [CI] = 0.04–2.18). On the assumption that women with a recent pregnancy had the same relapse rate as that of women without a recent pregnancy, the expected number of relapses in the former was 3.76, yielding an observed-to-expected ratio of 0.27 (95% exact CI = 0.01–1.51). Overall, the relapse rate peaked during the first year after diagnosis, whereas the pregnancy rate was highest during years 2 to 5 after diagnosis.

The investigators concluded: “We found no evidence that a pregnancy after diagnosis increases the relapse rate among women whose [Hodgkin lymphoma] is in remission. Survivors of [Hodgkin lymphoma] need to consider a range of factors when deciding about future reproduction. However, given the results of this study, the risk of pregnancy-associated relapse does not need to be considered.”

The study was supported by the Swedish Cancer Society, the Strategic Research Program in Epidemiology at the Karolinska Institutet, the Swedish Society of Medicine, and the Swedish Society for Medical Research.

Caroline E. Weibull, MSc, of the Karolinska Institutet, is the corresponding author of the Journal of Clinical Oncology article.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.