Gonadal Function and Fertility in Survivors After Hodgkin Lymphoma Treatment Within the German Hodgkin Study Group HD13 to HD15 Trials
Gonadal Function and Fertility in Survivors After Hodgkin Lymphoma Treatment Within the German Hodgkin Study Group HD13 to HD15 Trials
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DOI：
10.1200/jco.2012.44.3721
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发表时间：
2013-01-10
影响因子：
45.3
通讯作者：
Borchmann, Peter
中科院分区：
文献类型：
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作者：
Behringer, Karolin;Mueller, Horst;Borchmann, Peter
为了优化霍奇金淋巴瘤（HL）患者治疗前和生存期的生育建议，需要了解化疗的影响。因此，我们分析了性腺功能的幸存者HL。患者和MethodsWomen年龄小于40岁，男性年龄小于50岁，在诊断为持续缓解至少1年后，治疗在德国霍奇金淋巴瘤研究组HD 13至HD 15试验早期和晚期HL。激素参数，月经周期，性腺功能减退症的症状，和后代进行了evaluated.ResultsA共1,323（55%）的2,412接触女性和男性的幸存者进行了评估，为当前的分析（平均随访，46和48个月，分别）。促卵泡激素、抗苗勒管激素和β-氨基丁酸B水平与治疗强度显著相关（P <0.001）。在观察时间内，晚期治疗后的幸存者中观察到低出生率（女性，6.5%;男性，3.3%）。超过90%的早期HL女性幸存者报告了规律的月经周期（恢复时间大多= 30年：分别为82%和45%; P <0.001;恢复时间延长）。34%的年龄>= 30岁的女性患有严重的更年期症状（比预期的频率高出三到四倍）。相比之下，男性幸存者的平均睾酮水平在正常范围内，并报告没有增加的症状hypogonadism.ConclusionThe目前的分析在一大组HL的幸存者提供了良好的接地信息，目前使用的治疗方案的性腺毒性，并允许风险适应生育力的保护和全面的支持，在治疗和随访。J Clin Oncol 31：231-239. (C)2012年美国临床肿瘤学会
PurposeTo optimize fertility advice in patients with Hodgkin lymphoma (HL) before therapy and during survivorship, information on the impact of chemotherapy is needed. Therefore, we analyzed gonadal functions in survivors of HL.Patients and MethodsWomen younger than age 40 and men younger than 50 years at diagnosis in ongoing remission at least 1 year after therapy within the German Hodgkin Study Group HD13 to HD15 trials for early- and advanced-stage HL were included. Hormone parameters, menstrual cycle, symptoms of hypogonadism, and offspring were evaluated.ResultsA total of 1,323 (55%) of 2,412 contacted female and male survivors were evaluable for the current analysis (mean follow-up, 46 and 48 months, respectively). Follicle-stimulating hormone, anti-Mullerian hormone, and inhibin B levels correlated significantly with therapy intensity (P < .001). Low birth rates were observed in survivors after advanced-stage treatment within the observation time (women, 6.5%; men, 3.3%). Regular menstrual cycle was reported by more than 90% of female survivors of early-stage HL (recovery time mostly = 30 years: 82% v 45%, respectively; P < .001; prolonged recovery time). Thirty-four percent of women age >= 30 years suffered severe menopausal symptoms (three-to four-fold more frequently than expected). In contrast, male survivors had mean levels of testosterone within the normal range and reported no increased symptoms of hypogonadism.ConclusionThe present analysis in a large group of survivors of HL provides well-grounded information on gonadal toxicity of currently used treatment regimens and allows risk-adapted fertility preservation and comprehensive support during therapy and follow-up. J Clin Oncol 31:231-239. (C) 2012 by American Society of Clinical Oncology