Childbirth rates among women who survived Hodgkin lymphoma have improved and are now similar to those of the general population, according to study results conducted in Sweden and published in Journal of Clinical Oncology.
“Historically, treatments for Hodgkin lymphoma with the potential to cure have had negative effects on fertility,” Caroline E. Weibull,applied biostatistician and PhD student at Karolinska Institutet in Stockholm, and colleagues wrote. “Irradiation to the pelvic region; alkylating agents; and the mechlorethamine, vincristine, procarbazine and prednisone (MOPP) regimen are particularly gonadotoxic.”
Developments in treatment have lessened the effects of therapy on fertility.
“Previous register-based studies evaluating childbirth patterns have indicated a lower number of children born to patients with Hodgkin lymphoma than comparators but have not assessed childbearing by currently used treatments in a population-based setting,” Weibull and colleagues wrote.
The researchers used Swedish registers to identify 449 women who were diagnosed with Hodgkin lymphoma between 1992 and 2009, all of whom were in remission 9 months after diagnosis. The researchers matched these survivors by age and calendar year to 2,210 women in the general population and calculated the rates of first postdiagnosis birth.
Overall, 22% of survivors who did not relapse had a child during follow-up.
The rate of first childbirth among patients increased from 40.2 per 1,000 person-years during the period between 1992 and 1997 to 69.7 per 1,000 person-years during 2004 to 2009.
Women who were diagnosed between 2004 and 2009 had a cumulative probability of childbirth similar to that of the general population.
There were no observed differences between patients and the general population at 3 years after diagnosis, regardless of patients’ stage or treatment.
During the first 3 years, however, patients who underwent six to eight courses of bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine and prednisone had a lower rate of childbirth than the general population (HR = 0.23; 95% CI, 0.06-0.94). The same was true of patients who received six to eight courses of chemotherapy and radiotherapy (HR = 0.21; 95% CI, 0.07-0.65).
“The increase of childbirth rates over calendar time likely has a multifactorial explanation, reecting reduced toxicity in Hodgkin lymphoma treatment but also changes in attitudes and counseling,” Weibull and colleagues wrote. “The good childbearing potentialamong contemporarily treated patients, as well as the safety of a pregnancy after Hodgkin lymphoma (with no increased risk of relapse for the women and reports of good health for children), needs to be communicated to patients, because it can relieve unnecessary anxiety and concern.”
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