Skip to main content
Top
Published in: Annals of Hematology 8/2019

01-08-2019 | Fertility | Original Article

Pregnancy rate and outcome of pregnancies in long-term survivors of Hodgkin’s lymphoma

Authors: Francesco Gaudio, Claudia Nardelli, Paola Masciandaro, Tommasina Perrone, Filomena Emanuela Laddaga, Paola Curci, Raffaella Depalo, Ettore Cicinelli, Giorgina Specchia

Published in: Annals of Hematology | Issue 8/2019

Login to get access

Abstract

Thanks to the increased number of young survivors of Hodgkin’s lymphoma (HL), management of the pregnancies of women who have a history of exposure to chemotherapies and radiation therapy is becoming increasingly common. Many patients and clinicians are worried that pregnancy after the diagnosis of HL may increase the risk of relapse, despite a lack of empirical evidence to support such concerns. In the present study, we included 89 women diagnosed with HL between 2006 and 2015 under the age of 50 years, who were in complete remission and alive without relapse > 1 year after treatment. We determined the pregnancy rate, time to pregnancy, and the disease-free survival. We found no evidence of significant impairment of the fertility of female HL long-term survivors and no evidence that a pregnancy increases the relapse rate among women in remission from HL. Survivors of HL need to consider a range of factors when deciding on future reproduction.
Literature
1.
go back to reference Sutton PD, Mathews TJ (2004) National vital statistics report. Trends in characteristics of births by state: United States, 1990, 1995, and 2000–2002, vol 52, p 19 Sutton PD, Mathews TJ (2004) National vital statistics report. Trends in characteristics of births by state: United States, 1990, 1995, and 2000–2002, vol 52, p 19
2.
go back to reference Sleebos JE (2003) Low fertility rates in OECD countries: facts and policy responses. organisation for economic co-operation and development, Paris Sleebos JE (2003) Low fertility rates in OECD countries: facts and policy responses. organisation for economic co-operation and development, Paris
3.
go back to reference Gaudio F, Giordano A, Pavone V, Perrone T, Curci P, Pastore D, Delia M, De’ Risi C, Spina A, Liso V, Specchia G (2011) Outcome of very late relapse in patients with Hodgkin’s lymphomas. Adv Hematol 2011:707542CrossRefPubMed Gaudio F, Giordano A, Pavone V, Perrone T, Curci P, Pastore D, Delia M, De’ Risi C, Spina A, Liso V, Specchia G (2011) Outcome of very late relapse in patients with Hodgkin’s lymphomas. Adv Hematol 2011:707542CrossRefPubMed
4.
go back to reference Behringer K, Mueller H, Goergen H, Thielen I, Eibl AD, Stumpf V, Wessels C, Wiehlpütz M, Rosenbrock J, Halbsguth T, Reiners KS, Schober T, Renno JH, von Wolff M, van der Ven K, Kuehr M, Fuchs M, Diehl V, Engert A, Borchmann P (2013) Gonadal function and fertility in survivors after Hodgkin lymphoma treatment within the German Hodgkin Study Group HD13 to HD15 trials. J Clin Oncol 31:231–239CrossRefPubMed Behringer K, Mueller H, Goergen H, Thielen I, Eibl AD, Stumpf V, Wessels C, Wiehlpütz M, Rosenbrock J, Halbsguth T, Reiners KS, Schober T, Renno JH, von Wolff M, van der Ven K, Kuehr M, Fuchs M, Diehl V, Engert A, Borchmann P (2013) Gonadal function and fertility in survivors after Hodgkin lymphoma treatment within the German Hodgkin Study Group HD13 to HD15 trials. J Clin Oncol 31:231–239CrossRefPubMed
5.
go back to reference Barry RM, Diamond HD, Craver LF (1962) Influence of pregnancy on the course of Hodgkin’s disease. Am J Obstet Gynecol 84:445–454CrossRefPubMed Barry RM, Diamond HD, Craver LF (1962) Influence of pregnancy on the course of Hodgkin’s disease. Am J Obstet Gynecol 84:445–454CrossRefPubMed
6.
go back to reference Gobbi PG, Attardo-Parrinello A, Danesino M, Motta C, di Prisco AU, Rizzo SC, Ascari E (1984) Hodgkin’s disease and pregnancy. Haematologica 69:336–341PubMed Gobbi PG, Attardo-Parrinello A, Danesino M, Motta C, di Prisco AU, Rizzo SC, Ascari E (1984) Hodgkin’s disease and pregnancy. Haematologica 69:336–341PubMed
7.
go back to reference Lishner M, Zemlickis D, Degendorfer P, Panzarella T, Sutcliffe SB, Koren G (1992) Maternal and foetal outcome following Hodgkin’s disease in pregnancy. Br J Cancer 65:114–117CrossRefPubMedPubMedCentral Lishner M, Zemlickis D, Degendorfer P, Panzarella T, Sutcliffe SB, Koren G (1992) Maternal and foetal outcome following Hodgkin’s disease in pregnancy. Br J Cancer 65:114–117CrossRefPubMedPubMedCentral
8.
go back to reference Ruocco MG, Chaouat G, Florez L et al (2014) Regulatory T-cells in pregnancy: historical perspective, state of the art, and burning questions. Front Immunol 5:389CrossRefPubMedPubMedCentral Ruocco MG, Chaouat G, Florez L et al (2014) Regulatory T-cells in pregnancy: historical perspective, state of the art, and burning questions. Front Immunol 5:389CrossRefPubMedPubMedCentral
9.
go back to reference Kushekhar K, van den Berg A, Nolte I, Hepkema B, Visser L, Diepstra A (2014) Genetic associations in classical hodgkin lymphoma: a systematic review and insights into susceptibility mechanisms. Cancer Epidemiol Biomark Prev 23:2737–2747CrossRef Kushekhar K, van den Berg A, Nolte I, Hepkema B, Visser L, Diepstra A (2014) Genetic associations in classical hodgkin lymphoma: a systematic review and insights into susceptibility mechanisms. Cancer Epidemiol Biomark Prev 23:2737–2747CrossRef
10.
go back to reference Liu Y, Sattarzadeh A, Diepstra A, Visser L, van den Berg A (2014) The microenvironment in classical Hodgkin lymphoma: an actively shaped and essential tumor component. Semin Cancer Biol 24:15–22CrossRefPubMed Liu Y, Sattarzadeh A, Diepstra A, Visser L, van den Berg A (2014) The microenvironment in classical Hodgkin lymphoma: an actively shaped and essential tumor component. Semin Cancer Biol 24:15–22CrossRefPubMed
11.
go back to reference Gaudio F, Perrone T, Mestice A, Curci P, Giordano A, Delia M, Pastore D, Specchia G (2014 Jul) Peripheral blood CD4/CD19 cell ratio is an independent prognostic factor in classical Hodgkin lymphoma. Leuk Lymphoma 55(7):1596–1601CrossRefPubMed Gaudio F, Perrone T, Mestice A, Curci P, Giordano A, Delia M, Pastore D, Specchia G (2014 Jul) Peripheral blood CD4/CD19 cell ratio is an independent prognostic factor in classical Hodgkin lymphoma. Leuk Lymphoma 55(7):1596–1601CrossRefPubMed
12.
go back to reference Leber A, Teles A, Zenclussen AC (2010) Regulatory T cells and their role in pregnancy. Am J Reprod Immunol 63:445–459CrossRefPubMed Leber A, Teles A, Zenclussen AC (2010) Regulatory T cells and their role in pregnancy. Am J Reprod Immunol 63:445–459CrossRefPubMed
13.
go back to reference Behringer K, Breuer K, Reineke T, May M, Nogova L, Klimm B, Schmitz T, Wildt L, Diehl V, Engert A, German Hodgkin’s Lymphoma Study Group (2005) Secondary amenorrhea after Hodgkin’s lymphoma is influenced by age at treatment, stage of disease, chemotherapy regimen, and the use of oral contraceptives during therapy: a report from the German Hodgkin’s Lymphoma Study Group. J Clin Oncol 23(30):7555–7564CrossRefPubMed Behringer K, Breuer K, Reineke T, May M, Nogova L, Klimm B, Schmitz T, Wildt L, Diehl V, Engert A, German Hodgkin’s Lymphoma Study Group (2005) Secondary amenorrhea after Hodgkin’s lymphoma is influenced by age at treatment, stage of disease, chemotherapy regimen, and the use of oral contraceptives during therapy: a report from the German Hodgkin’s Lymphoma Study Group. J Clin Oncol 23(30):7555–7564CrossRefPubMed
14.
go back to reference Blumenfeld Z, Dann E, Avivi I, Epelbaum R, Rowe JM (2002) Fertility after treatment for Hodgkin’s disease. Ann Oncol 13(Suppl. 1):138–147CrossRefPubMed Blumenfeld Z, Dann E, Avivi I, Epelbaum R, Rowe JM (2002) Fertility after treatment for Hodgkin’s disease. Ann Oncol 13(Suppl. 1):138–147CrossRefPubMed
15.
go back to reference Howell S, Shalet S (1998) Gonadal damage from chemotherapy and radiotherapy. Endocrinol Metab Clin N Am 27(4):927–943CrossRef Howell S, Shalet S (1998) Gonadal damage from chemotherapy and radiotherapy. Endocrinol Metab Clin N Am 27(4):927–943CrossRef
16.
go back to reference Whitehead E, Shalet SM, Blackledge G, Todd I, Crowther D, Beardwell CG (1983) The effect of combination chemotherapy on ovarian function in women treated for Hodgkin’s disease. Cancer 52(6):988–993CrossRefPubMed Whitehead E, Shalet SM, Blackledge G, Todd I, Crowther D, Beardwell CG (1983) The effect of combination chemotherapy on ovarian function in women treated for Hodgkin’s disease. Cancer 52(6):988–993CrossRefPubMed
17.
go back to reference Bokemeyer C, Schmoll HJ, van Rhee J, Kuczyk M, Schuppert F, Poliwoda H (1994) Long-term gonadal toxicity after therapy for Hodgkin’s and non-Hodgkin’s lymphoma. Ann Hematol 68(3):105–110CrossRefPubMed Bokemeyer C, Schmoll HJ, van Rhee J, Kuczyk M, Schuppert F, Poliwoda H (1994) Long-term gonadal toxicity after therapy for Hodgkin’s and non-Hodgkin’s lymphoma. Ann Hematol 68(3):105–110CrossRefPubMed
18.
go back to reference Viviani S, Santoro A, Ragni G, Bonfante V, Bestetti O, Bona- donna G (1985) Gonadal toxicity after combination chemotherapy for Hodgkin’s disease. Comparative results of MOPP vs ABVD. Eur J Cancer Clin Oncol 21(5):601–605CrossRefPubMed Viviani S, Santoro A, Ragni G, Bonfante V, Bestetti O, Bona- donna G (1985) Gonadal toxicity after combination chemotherapy for Hodgkin’s disease. Comparative results of MOPP vs ABVD. Eur J Cancer Clin Oncol 21(5):601–605CrossRefPubMed
19.
go back to reference Anselmo AP, Cartoni C, Bellantuono P, Maurizi-Enrici R, Aboulkair N, Ermini M (1990) Risk of infertility in patients with Hodgkin’s disease treated with ABVD vs MOPP vs ABVD/ MOPP. Haematologica 75(2):155–158PubMed Anselmo AP, Cartoni C, Bellantuono P, Maurizi-Enrici R, Aboulkair N, Ermini M (1990) Risk of infertility in patients with Hodgkin’s disease treated with ABVD vs MOPP vs ABVD/ MOPP. Haematologica 75(2):155–158PubMed
20.
go back to reference Brusamolino E, Lunghi F, Orlandi E, Astori C, Passamonti F, Baraté C, Pagnucco G, Baio A, Franchini P, Lazzarino M, Bernasconi C (2000) Treatment of early- stage Hodgkin’s disease with four cycles of ABVD followed by adjuvant radio- therapy: analysis of efficacy and long-term toxicity. Haematologica 85(10):1032–1039PubMed Brusamolino E, Lunghi F, Orlandi E, Astori C, Passamonti F, Baraté C, Pagnucco G, Baio A, Franchini P, Lazzarino M, Bernasconi C (2000) Treatment of early- stage Hodgkin’s disease with four cycles of ABVD followed by adjuvant radio- therapy: analysis of efficacy and long-term toxicity. Haematologica 85(10):1032–1039PubMed
21.
go back to reference Andre M, Brice P, Cazals D et al (1997) Results of three courses of adriamycin, bleomycin, vindesine, and dacarbazine with subtotal nodal irradiation in 189 patients with nodal Hodgkin’s disease (stage I, II and IIIA). Hematol Cell Ther 39(2):59–65CrossRefPubMed Andre M, Brice P, Cazals D et al (1997) Results of three courses of adriamycin, bleomycin, vindesine, and dacarbazine with subtotal nodal irradiation in 189 patients with nodal Hodgkin’s disease (stage I, II and IIIA). Hematol Cell Ther 39(2):59–65CrossRefPubMed
22.
go back to reference van der Kaaij MA, Heutte N, Meijnders P et al (2012) Parenthood in survivors of Hodgkin lymphoma: an EORTC-GELA general population case-control study. J Clin Oncol 30:3854–3863CrossRefPubMed van der Kaaij MA, Heutte N, Meijnders P et al (2012) Parenthood in survivors of Hodgkin lymphoma: an EORTC-GELA general population case-control study. J Clin Oncol 30:3854–3863CrossRefPubMed
23.
go back to reference Stensheim H, Cvancarova M, Møller B, Fosså SD (2011) Pregnancy after adolescent and adult cancer: a population-based matched cohort study. Int J Cancer 129:1225–1236CrossRefPubMed Stensheim H, Cvancarova M, Møller B, Fosså SD (2011) Pregnancy after adolescent and adult cancer: a population-based matched cohort study. Int J Cancer 129:1225–1236CrossRefPubMed
24.
go back to reference Bonadonna G, Santoro A, Viviani S, Lombardi C, Ragni G (1984) Gonadal damage in Hodgkin’s disease from cancer chemotherapeutic regimens. Arch Toxicol Suppl 7:140–145CrossRefPubMed Bonadonna G, Santoro A, Viviani S, Lombardi C, Ragni G (1984) Gonadal damage in Hodgkin’s disease from cancer chemotherapeutic regimens. Arch Toxicol Suppl 7:140–145CrossRefPubMed
25.
go back to reference Hodgson DC, Pintilie M, Gitterman L, DeWitt B, Buckley CA, Ahmed S, Smith K, Schwartz A, Tsang RW, Crump M, Wells W, Sun A, Gospodarowicz MK (2007) Fertility among female hodgkin lymphoma survivors attempting pregnancy following ABVD chemotherapy. Hematol Oncol 25:11–15CrossRefPubMed Hodgson DC, Pintilie M, Gitterman L, DeWitt B, Buckley CA, Ahmed S, Smith K, Schwartz A, Tsang RW, Crump M, Wells W, Sun A, Gospodarowicz MK (2007) Fertility among female hodgkin lymphoma survivors attempting pregnancy following ABVD chemotherapy. Hematol Oncol 25:11–15CrossRefPubMed
26.
go back to reference Faddy MJ, Gosden RG, Gougeon A, Richardson SJ, Nelson JF (1992) Accelerated disappearance of ovarian follicles in midlife: implications for forecasting menopause. Hum Reprod 7:1342–1346CrossRef Faddy MJ, Gosden RG, Gougeon A, Richardson SJ, Nelson JF (1992) Accelerated disappearance of ovarian follicles in midlife: implications for forecasting menopause. Hum Reprod 7:1342–1346CrossRef
27.
go back to reference Jouet JP, Buchet-Bouverne B, Fenaux P et al (1988) Influence of pregnancy on the development of Hodgkin’s disease. Presse Med 17:423–427PubMed Jouet JP, Buchet-Bouverne B, Fenaux P et al (1988) Influence of pregnancy on the development of Hodgkin’s disease. Presse Med 17:423–427PubMed
28.
go back to reference Weibull CE, Eloranta S, Smedby KE, Björkholm M, Kristinsson SY, Johansson AL, Dickman PW, Glimelius I (2016 Feb 1) Pregnancy and the risk of relapse in patients diagnosed with Hodgkin lymphoma. J Clin Oncol 34(4):337–344CrossRefPubMed Weibull CE, Eloranta S, Smedby KE, Björkholm M, Kristinsson SY, Johansson AL, Dickman PW, Glimelius I (2016 Feb 1) Pregnancy and the risk of relapse in patients diagnosed with Hodgkin lymphoma. J Clin Oncol 34(4):337–344CrossRefPubMed
29.
go back to reference Lambe M, Hsieh CC, Tsaih SW et al (1998) Childbearing and the risk of Hodgkin’s disease. Cancer Epidemiol Biomark Prev 7:831–834 Lambe M, Hsieh CC, Tsaih SW et al (1998) Childbearing and the risk of Hodgkin’s disease. Cancer Epidemiol Biomark Prev 7:831–834
30.
go back to reference Møller H, Purushotham A, Linklater KM, Garmo H, Holmberg L, Lambe M, Yallop D, Devereux S (2013) Recent childbirth is an adverse prognostic factor in breast cancer and melanoma, but not in Hodgkin lymphoma. Eur J Cancer 49:3686–3693CrossRefPubMed Møller H, Purushotham A, Linklater KM, Garmo H, Holmberg L, Lambe M, Yallop D, Devereux S (2013) Recent childbirth is an adverse prognostic factor in breast cancer and melanoma, but not in Hodgkin lymphoma. Eur J Cancer 49:3686–3693CrossRefPubMed
31.
go back to reference Stensheim H, Møller B, van Dijk T, Fosså SD (2009) Cause-specific survival for women diagnosed with cancer during pregnancy or lactation: a registry- based cohort study. J Clin Oncol 27:45–51CrossRefPubMed Stensheim H, Møller B, van Dijk T, Fosså SD (2009) Cause-specific survival for women diagnosed with cancer during pregnancy or lactation: a registry- based cohort study. J Clin Oncol 27:45–51CrossRefPubMed
32.
go back to reference Sankila R, Heinävaara S, Hakulinen T (1994) Survival of breast cancer patients after subsequent term pregnancy: “healthy mother effect”. Am J Obstet Gynecol 170:818–823CrossRefPubMed Sankila R, Heinävaara S, Hakulinen T (1994) Survival of breast cancer patients after subsequent term pregnancy: “healthy mother effect”. Am J Obstet Gynecol 170:818–823CrossRefPubMed
Metadata
Title
Pregnancy rate and outcome of pregnancies in long-term survivors of Hodgkin’s lymphoma
Authors
Francesco Gaudio
Claudia Nardelli
Paola Masciandaro
Tommasina Perrone
Filomena Emanuela Laddaga
Paola Curci
Raffaella Depalo
Ettore Cicinelli
Giorgina Specchia
Publication date
01-08-2019
Publisher
Springer Berlin Heidelberg
Published in
Annals of Hematology / Issue 8/2019
Print ISSN: 0939-5555
Electronic ISSN: 1432-0584
DOI
https://doi.org/10.1007/s00277-019-03684-0

Other articles of this Issue 8/2019

Annals of Hematology 8/2019 Go to the issue
Live Webinar | 27-06-2024 | 18:00 (CEST)

Keynote webinar | Spotlight on medication adherence

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

WHO estimates that half of all patients worldwide are non-adherent to their prescribed medication. The consequences of poor adherence can be catastrophic, on both the individual and population level.

Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.

Prof. Kevin Dolgin
Prof. Florian Limbourg
Prof. Anoop Chauhan
Developed by: Springer Medicine
Obesity Clinical Trial Summary

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine

Highlights from the ACC 2024 Congress

Year in Review: Pediatric cardiology

Watch Dr. Anne Marie Valente present the last year's highlights in pediatric and congenital heart disease in the official ACC.24 Year in Review session.

Year in Review: Pulmonary vascular disease

The last year's highlights in pulmonary vascular disease are presented by Dr. Jane Leopold in this official video from ACC.24.

Year in Review: Valvular heart disease

Watch Prof. William Zoghbi present the last year's highlights in valvular heart disease from the official ACC.24 Year in Review session.

Year in Review: Heart failure and cardiomyopathies

Watch this official video from ACC.24. Dr. Biykem Bozkurt discusses last year's major advances in heart failure and cardiomyopathies.