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Parenthood Status and Use of Assisted Reproductive Techniques in Younger Hodgkin Lymphoma Survivors


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In a Danish population-based study reported in the Journal of Clinical Oncology, Øvlisen et al found that parenthood rates in younger Hodgkin lymphoma survivors who did not experience early relapse were similar to those in the general population, but that use of assisted reproductive techniques prior to live births was more common among survivors.

As stated by the investigators, “The majority of young adults with Hodgkin lymphoma are cured, but chemotherapy-induced infertility can have profound psychosocial consequences. Providing data on parenthood rates and use of assisted reproductive techniques after contemporary Hodgkin lymphoma treatment is important for patient counseling and survivorship care.”

Study Details

The study included Danish patients with Hodgkin lymphoma diagnosed from 2000 to 2015 at ages 18 to 40 years who achieved remission after first-line therapy and were alive without relapse 9 months after diagnosis. They were matched for age, sex, and parenthood status to five randomly selected persons from the general population. Parenthood rates were defined as the rate of first live birth per 1,000 person-years, starting from 9 months after Hodgkin lymphoma diagnosis (index date).

Key Findings

A total of 793 Hodgkin lymphoma survivors (434 male, 359 female) and 3,965 matched comparators were included in the analysis.

Median follow-up was 8.7 years. Progression-free survival at 5 years from index date was 90.6% among male survivors and 89.4% among female survivors.

KEY POINTS

  • The 10-year cumulative incidence of first live birth was 38.3% vs 39.9% for male survivors vs comparators, and 42.0% vs 43.3% for female survivors vs comparators.
  • Treatment with BEACOPP was associated with lower parenthood rates per 1,000 person-years for male survivors vs matched comparators but not for female survivors.
  • Among survivors with a live birth after the index date, 21.6% of male survivors vs 6.3% of comparators and 13.6% of female survivors vs 5.5% of comparators had first live birth after use of assisted reproductive techniques.

The 10-year cumulative incidence of first live birth was 38.3% vs 39.9% for male survivors vs comparators, and 42.0% vs 43.3% for female survivors vs comparators. Rates per 1,000 person-years were 56.2 vs 57.1 for male survivors vs comparators (P = .871) and 63.8 vs 61.2 for female survivors vs comparators (P = .672). 

Treatment with BEACOPP (bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone) was associated with lower parenthood rates per 1,000 person-years for male survivors (n = 62) vs matched comparators (28.1 vs 60.8, P = .020) but not for female survivors (n = 26; 61.2 vs 62.5, P = .956).

Among survivors with a live birth after the index date, 21.6% of male survivors vs 6.3% of comparators (P < .001) and 13.6% of female survivors vs 5.5% of comparators (P = .001) had first live birth after use of assisted reproductive techniques. Use of assisted reproductive techniques for reduced fertility was more common among male survivors vs comparators (50.0% vs 22.9%, P < .001) but not among female survivors vs comparators (50% vs 50%).

No differences in gestational age, Apgar score, or newborn measurements were observed between births for Hodgkin lymphoma survivors vs comparators.

The investigators concluded, “The parenthood rates for Hodgkin lymphoma survivors who have not experienced relapse were generally similar to the general population. However, assisted reproductive techniques were used more often before the first live birth in Hodgkin lymphoma survivors, which is relevant information when discussing possible long-term side effects and fertility-preserving treatment options.”

Andreas K. Øvlisen, MD, of the Department of Hematology, Aalborg University Hospital, Aalborg, is the corresponding author for the Journal of Clinical Oncology article.  

Disclosure: The study was supported by the Danish Lymphoma Group and A.P. Møller Fonden, Danish Cancer Society and Aalborg University, and Nordic Cancer Union. For full disclosures of the study authors, visit ascopubs.org.

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®.
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