Publication Date:
2013-11-15
Description:
Background In young females with lymphoma, the impact of immunochemotherapy on fertility status has been poorly studied. Primary mediastinal B-cell lymphoma (PMBL) predominantly affects young females and is highly curable with the dose-adjusted EPOCH-rituximab (DA-EPOCH-R) regimen (Dunleavy et al., NEJM 2013:368;1408). We therefore identified this group of PMBL patients as an excellent population to study fertility status and evaluated the impact of DA-EPOCH-R on gonadal function of females aged 50 years or less. Methods A questionnaire was first mailed to 27 patients, and this was followed by a semi-structured phone interview to obtain information on patients' medical and gynecologic/obstetric histories before PMBL diagnosis, during treatment and after its completion. Serum estradiol (E2), luteinizing hormone (LH) and follicle stimulating hormone (FSH) levels were analyzed before commencing chemotherapy, following 5-6 cycles of DA-EPOCH-R, and 10-18 months after treatment completion. Results All patients included in the study completed 6-8 cycles of DA-EPOCH-R and were in complete remission from PMBL at a median follow-up of 63 months. Median age at diagnosis was 30.5 years (r 21-50). Twenty-three patients participated in the questionnaire. Prior to chemotherapy, twenty of twenty-three were menstruating, three patients were not. Of the twenty menstruating patients treated with DA-EPOCH-R three were unsure of their menstrual histories during chemotherapy, fourteen (70%) developed amenorrhea and three (15%), all younger than 25 years, continued to menstruate. After completion of chemotherapy, fifteen of the twenty patients (75%) had menstrual periods. All were 35 years or younger. Five patients (25%) remained amenorrheic following completion of chemotherapy, however one had a hysterectomy shortly after treatment completion. To date six of twenty (30%) patients have conceived naturally and delivered healthy children with nine not yet desiring motherhood. On laboratory evaluations performed before treatment, after 5-6 cycles of DA-EPOCH-R and 10-18 months after completion of chemotherapy, median serum LH levels were 2.5, 33.4 and 4.6 U/L respectively, median FSH values at the same time points were 3.6, 69.5 and 8 U/L, while median E2 levels were 24.4,
Print ISSN:
0006-4971
Electronic ISSN:
1528-0020
Topics:
Biology
,
Medicine
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