GnRHa Not Efficient In Preventing Premature Ovarian Failure in Lymphoma

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Gonadotropin-releasing hormone agonist may not be efficient in preventing chemotherapy-induced premature ovarian failure.
Gonadotropin-releasing hormone agonist may not be efficient in preventing chemotherapy-induced premature ovarian failure.

Gonadotropin-releasing hormone agonist (GnRHa) may not be efficient in preventing chemotherapy-induced premature ovarian failure (POF) in young patients with lymphoma, according to a study published in the Journal of Clinical Oncology.1

In addition, GnRHa may not influence future pregnancy rate.

Researchers led by Isabelle Demeestere, MD, PhD, of the Université Libre de Bruxelles in Belgium, looked at 129 patients with lymphoma who were randomly assigned to receive either triptorelin plus norethisterone or norethisterone alone during chemotherapy. Upon 2, 3, 4, and 5 to 7 years of follow-up, they reported for ovarian function and fertility.

Primary endpoint was POF, which was defined as at least 1 follicle-stimulating hormone value of greater than 40 IU/L after2 years of follow-up.

In total, 67 patients were found to have available data after a median follow-up time of 5.33 years in the GnRHa group and 5.58 years in the control group.

Upon multivariate logistic regression analysis, they found a significantly increased risk of POF in patients according to age, the conditioning regimen for hematopoietic stem cell transplant, and the cumulative dose of cyclophosphamide, but not with co-administration of GnRHa during chemotherapy.

Through evaluting anti-Müllerian hormone and follicle-stimulating hormone levels, they observed that ovarian reserve was similar in both groups, with the 43% of patients in the GnRHa group who achieved pregnancy compared to 43% in the control group.

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“These results reopen the debate about the drug's benefit in that it should not be recommended as standard for fertility preservation in patients with lymphoma,” the authors noted.

Reference

  1. Demeestere I, Brice P, Peccatori FA, et al. No Evidence for the Benefit of Gonadotropin-Releasing Hormone Agonist in Preserving Ovarian Function and Fertility in Lymphoma Survivors Treated With Chemotherapy: Final Long-Term Report of a Prospective Randomized Trial. [published online ahead of print May 23, 2016.] J Clin Oncol. doi: 10.1200/JCO.2015.65.8864.

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