Gonadotropin-releasing hormone agonist decreases chemotherapy-induced gonadotoxicity and premature ovarian failure in young female patients with Hodgkin lymphoma

• Published in: Fertility and sterility Vol. 89; no. 1; pp. 166 - 173
• Main Authors: Blumenfeld, Zeev, Avivi, Irith, Eckman, Ari, Epelbaum, Ron, Rowe, Jacob M., Dann, Eldad J.
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 2008; Elsevier Science
• Subjects: Adolescent; Adult; Antineoplastic Combined Chemotherapy Protocols - adverse effects; Biological and medical sciences; chemotherapy; Drug Administration Schedule; Female; Fertility Agents, Female - administration & dosage; Fertility preservation; GnRH agonist; gonadotoxicity; Gonadotropin-Releasing Hormone - agonists; Gynecology. Andrology. Obstetrics; Hematologic and hematopoietic diseases; Hodgkin Disease - drug therapy; Hodgkin Disease - physiopathology; Humans; Injections; Internal Medicine; Leukemias. Malignant lymphomas. Malignant reticulosis. Myelofibrosis; Medical sciences; Menstrual Cycle - drug effects; Obstetrics and Gynecology; Ovary - drug effects; Ovary - physiopathology; Pregnancy; Pregnancy Rate; premature ovarian failure; Primary Ovarian Insufficiency - chemically induced; Primary Ovarian Insufficiency - physiopathology; Primary Ovarian Insufficiency - prevention & control; Time Factors; Treatment Outcome; Triptorelin Pamoate - administration & dosage; gonadotoxicity; Fertility preservation; chemotherapy; premature ovarian failure; GnRH agonist; Endocrinopathy; Premature; Agonist; Conservation; Gonadotropin RH; Ovarian failure; Fertility; Lymphoproliferative syndrome; Female; Human; Preservation; Gynecology; Hodgkin disease; Malignant hemopathy; Lymphoma; Obstetrics; Female genital diseases; Ovarian diseases; Chemotherapy; Treatment; Young adult; Cancer
• ISSN: 0015-0282; 1556-5653; 1556-5653
• DOI: 10.1016/j.fertnstert.2007.02.010

To minimize the gonadotoxic effect of chemotherapy by the cotreatment with a GnRH agonistic analogue (GnRH-a). Prospective nonrandomized study with concurrent and historical controls. University medical center. One hundred fifteen female patients with Hodgkin lymphoma (HL). Sixty-five patients received a monthly injection of GnRH-a, administered before starting chemotherapy until its conclusion, up to a maximum of 6 months. Thirty-five patients were treated with ABVD and 76 with a procarbazine-containing regimen. This group was compared with a control group of 46 women who were treated concurrently with similar chemotherapy (n = 26) without GnRH-a or were historical controls (n = 20). Cyclic ovarian function (COF) versus premature ovarian failure (POF). The ovarian function could be determined in 111 patients. In the GnRH-a/chemotherapy group, 63 out of 65 patients resumed ovulation and regular menses (96.9 %), compared with 63% of the 46 control subjects. Twenty of the 22 patients in the BEACOPP/escalated BEACOPP/GnRH-a cotreatment resumed cyclic ovarian function versus 9 of the 14 in the chemotherapy-only group. All 17 MOPP/ABV/GnRH-a cotreated patients resumed COF versus 11 of the 22 in the chemotherapy-only group. There was no significant effect of the GnRH-a cotreatment regarding COF in the ABVD group. There were no significant differences in the cumulative doses of the various alkylating agents between the two groups. Cotreatment with GnRH-a may reduce ovarian damage significantly in female patients treated for HL and should be considered in addition to assisted reproduction for women in reproductive age receiving gonadotoxic chemotherapy.