Long-term ovarian function in women treated with CHOP or CHOP plus etoposide for aggressive lymphoma.
Long-term ovarian function in women treated with CHOP or CHOP plus etoposide for aggressive lymphoma.
复制标题
使用 CHOP 或 CHOP 加依托泊苷治疗侵袭性淋巴瘤的女性的长期卵巢功能。
作者：
J. Meissner;D. Tichy;V. Katzke;T. Kühn;S. Dietrich;T. Schmitt;M. Ziepert;E. Kuhnt;T. Rixecker;M. Zorn;M. Witzens‐Harig;M. Pfreundschuh;A. Ho
背景
化疗相关的卵巢损伤不仅包括不孕，还包括过早绝经。据报道，后者是乳腺癌或霍奇金淋巴瘤的烷化化疗的结果。在这项研究中，我们评估了 CHOP（环磷酰胺、阿霉素、长春新碱和泼尼松）类疗法对侵袭性非霍奇金淋巴瘤 (NHL) 患者卵巢功能的长期影响。
患者和方法
在 Mabthera 国际试验或德国 NHL 研究组的 NHL-B1 试验中，接受 CHOP 或 CHOP 加依托泊苷 (CHOEP) 治疗后的长期幸存者被要求填写一份调查问卷，并同意采血进行激素评估。
结果
参加上述临床试验时，81 名接触过的患者中，中位年龄为 32.5 岁，共有 46 名患者回答了调查问卷。治疗完成后的中位随访时间为 14 年。与一般人群相比，患者末次月经出血发生时间明显更早（47 岁与 51 岁，P < 0.0001）。与一般人群中更年期症状的分布相比，患有中度或重度更年期症状的女性比例有所增加。在同意参加实验室分析的 23 名患者中，与一般人群的相应年龄组相比，作为卵巢储备标志物的抗米勒激素有所下降。
结论
虽然大多数女性患者在类似CHOP的化疗后恢复了生育能力，但晚期卵巢功能障碍经常发生。因此，在咨询时意识到此类延迟副作用非常重要。
BACKGROUND
Chemotherapy-associated ovarian damage comprises not only infertility, but also premature menopause. The latter has been reported as a consequence of alkylating chemotherapy for breast cancer or Hodgkin's lymphoma. In this study, we assessed the long-term impact of CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisone)-like regimens on ovarian function in patients with aggressive non-Hodgkin lymphoma (NHL).
PATIENTS AND METHODS
Long-term survivors after CHOP or CHOP plus etoposide (CHOEP) treatment within the Mabthera International Trial or the NHL-B1 trial of the German NHL Study Group were requested to respond to a questionnaire and to consent to blood sampling for hormone assessment.
RESULTS
A total of 46 of 81 contacted patients with a median age of 32.5 years at the time of enrolment into the aforementioned clinical trials responded to the questionnaire. The median follow-up after completion of treatment was 14 years. Last menstrual bleeding occurred significantly earlier in patients compared with the general population (47 versus 51 years, P < 0.0001). In comparison to the distribution of menopausal symptoms in the general population, the percentage of women with moderate or severe menopausal symptoms was increased. In 23 patients who agreed to participate in laboratory analyses, anti-Muller hormone as a marker of ovarian reserve was decreased when compared with correspondent age groups of the general population.
CONCLUSION
Although most female patients regain fertility after CHOP-like chemotherapy, late ovarian impairment occurs frequently. Therefore, awareness of such delayed side-effects at the time of counselling is of importance.
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