Women aged 35 years or older diagnosed with Hodgkin lymphoma should discuss fertility preservation prior to treatment, based on results of a study that found reduced ovarian recovery after treatment with doxorubicin, bleomycin, vinblastine (ABVD) or AVD.1
The study also showed that all women with Hodgkin lymphoma treated with bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisolone (BEACOPP) had little recovery of ovarian function after treatment.
“This study shows the degree of difference in how damaging different chemotherapy regimens are to the ovary,” Richard A. Anderson, MD, of MRC Centre for Reproductive Health, Queens Medical Research Institute, University of Edinburgh in the United Kingdom, told Cancer Therapy Advisor. “Importantly, we showed that even with low-damage therapy, recovery is incomplete in women over age 35, whereas it appears to be complete in younger women.”
The analysis looked at women aged 18 to 45 enrolled in the phase 3 RATHL trial. RATHL included patients with Hodgkin lymphoma, stage IIB-IV or IIA with adverse features. Patients were randomly assigned to 2 cycles of ABVD or AVD followed by interim PET-CT scan. Those patients with negative scans were randomly assigned to continue ABVD or AVD for 4 more cycles. Patients with positive interim scans were escalated to BEACOPP for 4 cycles.
Ovarian function was assessed before treatment, during chemotherapy, and annually for 3 years using both serum antimullerian hormone and follicle-stimulating hormone measurements.
During chemotherapy, levels of antimullerian hormone decreased in all patients. In patients assigned ABVD-AVD, concentrations decreased from a median of 9.8 pmol/L prior to treatment to 1.7 pmol/L at the end of treatment (P < .0001). After completion of ABVD-AVD, concentrations increased to a median of 10.5 pmol/L.