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.
—Anthony Swerdlow, DSc
Previous research has suggested that women with Hodgkin lymphoma who receive certain types of chemotherapy or radiotherapy are at increased risk of future infertility, but there was insufficient information to provide patients with detailed advice. In a study published in the Journal of the National Cancer Institute, Swerdlow et al estimated the risk of premature menopause in women being treated for Hodgkin lymphoma.1 The findings are based on the experience of more than 2,000 young women in England and Wales over a period of more than 40 years.
The new study, led by scientists at The Institute of Cancer Research, London, provides precise estimates of risk for women depending on which treatment types and doses they received and at what age, allowing doctors to give them detailed advice about their risks of future infertility.
The research team followed 2,127 women who had been treated for Hodgkin lymphoma in England and Wales at ages younger than 36 years from 1960 to 2004. All patients had received treatment with chest radiotherapy, sometimes alongside other treatments. Follow-up took place from 2008 through 2012.
Some 605 of the women in the study underwent nonsurgical menopause before the age of 40. 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 the age they received them.
Increases in Premature Menopause
The researchers produced a risk table which could help improve the advice that clinicians are able to give to women who have undergone treatment for the disease. Several of the treatments caused a sharp increase in premature menopause risk.
For example, a woman who had received six or more cycles of a standard chemotherapy regimen without pelvic radiotherapy in her late 20s had an approximately 18% chance of undergoing menopause by the age of 30, or 58% by age 40.
Overall, there was a 20-fold increased risk of premature menopause after ovarian radiotherapy and also after some specific chemotherapy regimens. Risk of menopause by age 40 was 81% after receiving ovarian radiotherapy of at least 5 Gy, and up to 75% after chemotherapy, depending on the type. There was no statistically increased risk associated with ABVD (doxorubicin, bleomycin, vinblastine, dacarbazine).
“Hodgkin lymphoma often affects younger women, and although fortunately most survive the disease, treatments including certain types of chemotherapy and pelvic radiotherapy can lead to premature menopause,” said study leader Anthony Swerdlow, DSc, of The Institute of Cancer Research, London. “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. I’m extremely grateful to the patients and doctors who made it possible for us to produce this information.” ■
Disclosure: The research was supported by Breakthrough Breast Cancer and the European Commission. For full disclosures for the study authors, visit jnci.oxfordjournals.org
1. Swerdlow AJ, Cooke R, Bates A, et al: Risk of premature menopause after treatment for Hodgkin’s lymphoma. J Natl Cancer Inst. August 2014 (early release online).