CRYOPRESERVATION OF MATURE OOCYTES TO PRESERVE FERTILITY IS FEASIBLE WITHOUT TREATMENT DELAY IN YOUNG ADULT LYMPHOMA PATIENTS
(Abstract release date: 05/19/16)
EHA Library. Viviani S. 06/09/16; 132989; E1440
Disclosure(s): No relationship to disclose
Dr. Simonetta Viviani
Contributions
Contributions
Abstract
Abstract: E1440
Type: Eposter Presentation
Background
Advances in the treatment of lymphomas have led to a substantial decline in the mortality rate and a remarkable improvement in the long-term outcomes, that has raised patients’ expectations of a better quality of life, among which fertility preservation represents an imminent wish. However the majority of treatment protocols consist of combination chemotherapy (CT) which may lead to infertility due to severe injury to ovarian reserve, when alkylating agents –containing regimens, CT combined with radiotherapy (RT) on the pelvis, high-dose CT and autologous hematopoietic stem cell reinfusion and/or allogeneic bone marrow transplantation have to be given in the course of the disease.Attempts to prevent ovarian damage during CT±RT include a) the concomitant administration of Gonadotropin Releasing Hormone (GnRH) agonists, but results of randomized trials have led to controversial results, b) ovarian tissue cryopreservation, which requires two subsequent laparoscopic sessions, carries the possibility of malignant cells reimplantation and has produced only a limited number of published live births c) mature oocyte cryopreservation, d) embryo cryopreservation, which is not admitted by italian rules and requires the availability of a male partner.
Aims
To evaluate in a prospective observational study the acceptability and feasibility of the procedure of ovarian hyper-stimulation and mature oocyte retrieval and cryopreservation, in female patients with newly diagnosed Hodgkin (HL) and non Hodgkin lymphoma (NHL).
Methods
Female patients aged ≥ 18 years and ≤ 38 years with histologically proven untreated HL or NHL at any stage, diagnosed at Istituto Nazionale Tumori of Milan, without contraindications to ovarian stimulation, i.e. symptomatic rapid progressive disease, and/or superior vena cava syndrome, active viral infectious disease and ovarian failure, were eligible for the study. After having addressed expected gonadal toxicity of CT±RT during their first haematological evaluation, they were referred to gynecological counseling. Ovarian reserve was assessed by antral follicle count regardless of the menstrual cycle. If the woman consented, she underwent ovarian hyper-stimulation according to a random start protocol. Briefly, gonadotropins were started the same day regardless of the menstrual cycle and the cycle was monitored through serial ultrasounds to tailor the initiation of GnRH antagonists and to identify the most proper time for ovulation trigger
Results
From July 2013 to December 2015 20 patients were enrolled into the study, median age was 27 years (range, 19-35), 16 patients were diagnosed with HL, 4 with NHL (2 DLBCL, 1 PMBCL, 1 follicular). Median time from first hematological visit and gynecological counselling was 2 days (range, 0-10), median time from diagnostic biopsy and gynecological counselling was 14 days (range, 0-29). 11 out of 20 (55%) patients were considered eligible and/or accepted to undergo ovarian stimulation; 6 patients refused due to personal reasons, 1 due to gynecological reasons (ovarian cysts), 1 due to symptomatic progressive disease after the first gynecological visit and in 1 DLBCL NHL patient stimulation was suspended due to initial superior vena cava syndrome. Median time from first gynecological visit and oocyte retrieval was 13 days (range, 12-16); median number of retrieved oocytes was 16 (range, 11-32) and median number of cryopreserved oocytes was 14 (range, 9-23). Median time from oocyte retrieval and CT start was 4 days (2-14).
Conclusion
Preliminary results of this study document that ovarian hyper-stimulation and oocyte retrieval using a random start protocol is feasibile in young females diagnosed with HL or NHL without a significant delay in CT start. The number of mature oocyte cryopreserved is adequate and comparable to non-cancer patients. Oocyte cryopreservation should be systematically considered in lymphoma patients of childbearing age before starting gonadoxic therapy and should be preferably performed during staging procedures.
Session topic: E-poster
Keyword(s): Hodgkin's lymphoma, Lymphoma therapy, NHL
Type: Eposter Presentation
Background
Advances in the treatment of lymphomas have led to a substantial decline in the mortality rate and a remarkable improvement in the long-term outcomes, that has raised patients’ expectations of a better quality of life, among which fertility preservation represents an imminent wish. However the majority of treatment protocols consist of combination chemotherapy (CT) which may lead to infertility due to severe injury to ovarian reserve, when alkylating agents –containing regimens, CT combined with radiotherapy (RT) on the pelvis, high-dose CT and autologous hematopoietic stem cell reinfusion and/or allogeneic bone marrow transplantation have to be given in the course of the disease.Attempts to prevent ovarian damage during CT±RT include a) the concomitant administration of Gonadotropin Releasing Hormone (GnRH) agonists, but results of randomized trials have led to controversial results, b) ovarian tissue cryopreservation, which requires two subsequent laparoscopic sessions, carries the possibility of malignant cells reimplantation and has produced only a limited number of published live births c) mature oocyte cryopreservation, d) embryo cryopreservation, which is not admitted by italian rules and requires the availability of a male partner.
Aims
To evaluate in a prospective observational study the acceptability and feasibility of the procedure of ovarian hyper-stimulation and mature oocyte retrieval and cryopreservation, in female patients with newly diagnosed Hodgkin (HL) and non Hodgkin lymphoma (NHL).
Methods
Female patients aged ≥ 18 years and ≤ 38 years with histologically proven untreated HL or NHL at any stage, diagnosed at Istituto Nazionale Tumori of Milan, without contraindications to ovarian stimulation, i.e. symptomatic rapid progressive disease, and/or superior vena cava syndrome, active viral infectious disease and ovarian failure, were eligible for the study. After having addressed expected gonadal toxicity of CT±RT during their first haematological evaluation, they were referred to gynecological counseling. Ovarian reserve was assessed by antral follicle count regardless of the menstrual cycle. If the woman consented, she underwent ovarian hyper-stimulation according to a random start protocol. Briefly, gonadotropins were started the same day regardless of the menstrual cycle and the cycle was monitored through serial ultrasounds to tailor the initiation of GnRH antagonists and to identify the most proper time for ovulation trigger
Results
From July 2013 to December 2015 20 patients were enrolled into the study, median age was 27 years (range, 19-35), 16 patients were diagnosed with HL, 4 with NHL (2 DLBCL, 1 PMBCL, 1 follicular). Median time from first hematological visit and gynecological counselling was 2 days (range, 0-10), median time from diagnostic biopsy and gynecological counselling was 14 days (range, 0-29). 11 out of 20 (55%) patients were considered eligible and/or accepted to undergo ovarian stimulation; 6 patients refused due to personal reasons, 1 due to gynecological reasons (ovarian cysts), 1 due to symptomatic progressive disease after the first gynecological visit and in 1 DLBCL NHL patient stimulation was suspended due to initial superior vena cava syndrome. Median time from first gynecological visit and oocyte retrieval was 13 days (range, 12-16); median number of retrieved oocytes was 16 (range, 11-32) and median number of cryopreserved oocytes was 14 (range, 9-23). Median time from oocyte retrieval and CT start was 4 days (2-14).
Conclusion
Preliminary results of this study document that ovarian hyper-stimulation and oocyte retrieval using a random start protocol is feasibile in young females diagnosed with HL or NHL without a significant delay in CT start. The number of mature oocyte cryopreserved is adequate and comparable to non-cancer patients. Oocyte cryopreservation should be systematically considered in lymphoma patients of childbearing age before starting gonadoxic therapy and should be preferably performed during staging procedures.
Session topic: E-poster
Keyword(s): Hodgkin's lymphoma, Lymphoma therapy, NHL
Abstract: E1440
Type: Eposter Presentation
Background
Advances in the treatment of lymphomas have led to a substantial decline in the mortality rate and a remarkable improvement in the long-term outcomes, that has raised patients’ expectations of a better quality of life, among which fertility preservation represents an imminent wish. However the majority of treatment protocols consist of combination chemotherapy (CT) which may lead to infertility due to severe injury to ovarian reserve, when alkylating agents –containing regimens, CT combined with radiotherapy (RT) on the pelvis, high-dose CT and autologous hematopoietic stem cell reinfusion and/or allogeneic bone marrow transplantation have to be given in the course of the disease.Attempts to prevent ovarian damage during CT±RT include a) the concomitant administration of Gonadotropin Releasing Hormone (GnRH) agonists, but results of randomized trials have led to controversial results, b) ovarian tissue cryopreservation, which requires two subsequent laparoscopic sessions, carries the possibility of malignant cells reimplantation and has produced only a limited number of published live births c) mature oocyte cryopreservation, d) embryo cryopreservation, which is not admitted by italian rules and requires the availability of a male partner.
Aims
To evaluate in a prospective observational study the acceptability and feasibility of the procedure of ovarian hyper-stimulation and mature oocyte retrieval and cryopreservation, in female patients with newly diagnosed Hodgkin (HL) and non Hodgkin lymphoma (NHL).
Methods
Female patients aged ≥ 18 years and ≤ 38 years with histologically proven untreated HL or NHL at any stage, diagnosed at Istituto Nazionale Tumori of Milan, without contraindications to ovarian stimulation, i.e. symptomatic rapid progressive disease, and/or superior vena cava syndrome, active viral infectious disease and ovarian failure, were eligible for the study. After having addressed expected gonadal toxicity of CT±RT during their first haematological evaluation, they were referred to gynecological counseling. Ovarian reserve was assessed by antral follicle count regardless of the menstrual cycle. If the woman consented, she underwent ovarian hyper-stimulation according to a random start protocol. Briefly, gonadotropins were started the same day regardless of the menstrual cycle and the cycle was monitored through serial ultrasounds to tailor the initiation of GnRH antagonists and to identify the most proper time for ovulation trigger
Results
From July 2013 to December 2015 20 patients were enrolled into the study, median age was 27 years (range, 19-35), 16 patients were diagnosed with HL, 4 with NHL (2 DLBCL, 1 PMBCL, 1 follicular). Median time from first hematological visit and gynecological counselling was 2 days (range, 0-10), median time from diagnostic biopsy and gynecological counselling was 14 days (range, 0-29). 11 out of 20 (55%) patients were considered eligible and/or accepted to undergo ovarian stimulation; 6 patients refused due to personal reasons, 1 due to gynecological reasons (ovarian cysts), 1 due to symptomatic progressive disease after the first gynecological visit and in 1 DLBCL NHL patient stimulation was suspended due to initial superior vena cava syndrome. Median time from first gynecological visit and oocyte retrieval was 13 days (range, 12-16); median number of retrieved oocytes was 16 (range, 11-32) and median number of cryopreserved oocytes was 14 (range, 9-23). Median time from oocyte retrieval and CT start was 4 days (2-14).
Conclusion
Preliminary results of this study document that ovarian hyper-stimulation and oocyte retrieval using a random start protocol is feasibile in young females diagnosed with HL or NHL without a significant delay in CT start. The number of mature oocyte cryopreserved is adequate and comparable to non-cancer patients. Oocyte cryopreservation should be systematically considered in lymphoma patients of childbearing age before starting gonadoxic therapy and should be preferably performed during staging procedures.
Session topic: E-poster
Keyword(s): Hodgkin's lymphoma, Lymphoma therapy, NHL
Type: Eposter Presentation
Background
Advances in the treatment of lymphomas have led to a substantial decline in the mortality rate and a remarkable improvement in the long-term outcomes, that has raised patients’ expectations of a better quality of life, among which fertility preservation represents an imminent wish. However the majority of treatment protocols consist of combination chemotherapy (CT) which may lead to infertility due to severe injury to ovarian reserve, when alkylating agents –containing regimens, CT combined with radiotherapy (RT) on the pelvis, high-dose CT and autologous hematopoietic stem cell reinfusion and/or allogeneic bone marrow transplantation have to be given in the course of the disease.Attempts to prevent ovarian damage during CT±RT include a) the concomitant administration of Gonadotropin Releasing Hormone (GnRH) agonists, but results of randomized trials have led to controversial results, b) ovarian tissue cryopreservation, which requires two subsequent laparoscopic sessions, carries the possibility of malignant cells reimplantation and has produced only a limited number of published live births c) mature oocyte cryopreservation, d) embryo cryopreservation, which is not admitted by italian rules and requires the availability of a male partner.
Aims
To evaluate in a prospective observational study the acceptability and feasibility of the procedure of ovarian hyper-stimulation and mature oocyte retrieval and cryopreservation, in female patients with newly diagnosed Hodgkin (HL) and non Hodgkin lymphoma (NHL).
Methods
Female patients aged ≥ 18 years and ≤ 38 years with histologically proven untreated HL or NHL at any stage, diagnosed at Istituto Nazionale Tumori of Milan, without contraindications to ovarian stimulation, i.e. symptomatic rapid progressive disease, and/or superior vena cava syndrome, active viral infectious disease and ovarian failure, were eligible for the study. After having addressed expected gonadal toxicity of CT±RT during their first haematological evaluation, they were referred to gynecological counseling. Ovarian reserve was assessed by antral follicle count regardless of the menstrual cycle. If the woman consented, she underwent ovarian hyper-stimulation according to a random start protocol. Briefly, gonadotropins were started the same day regardless of the menstrual cycle and the cycle was monitored through serial ultrasounds to tailor the initiation of GnRH antagonists and to identify the most proper time for ovulation trigger
Results
From July 2013 to December 2015 20 patients were enrolled into the study, median age was 27 years (range, 19-35), 16 patients were diagnosed with HL, 4 with NHL (2 DLBCL, 1 PMBCL, 1 follicular). Median time from first hematological visit and gynecological counselling was 2 days (range, 0-10), median time from diagnostic biopsy and gynecological counselling was 14 days (range, 0-29). 11 out of 20 (55%) patients were considered eligible and/or accepted to undergo ovarian stimulation; 6 patients refused due to personal reasons, 1 due to gynecological reasons (ovarian cysts), 1 due to symptomatic progressive disease after the first gynecological visit and in 1 DLBCL NHL patient stimulation was suspended due to initial superior vena cava syndrome. Median time from first gynecological visit and oocyte retrieval was 13 days (range, 12-16); median number of retrieved oocytes was 16 (range, 11-32) and median number of cryopreserved oocytes was 14 (range, 9-23). Median time from oocyte retrieval and CT start was 4 days (2-14).
Conclusion
Preliminary results of this study document that ovarian hyper-stimulation and oocyte retrieval using a random start protocol is feasibile in young females diagnosed with HL or NHL without a significant delay in CT start. The number of mature oocyte cryopreserved is adequate and comparable to non-cancer patients. Oocyte cryopreservation should be systematically considered in lymphoma patients of childbearing age before starting gonadoxic therapy and should be preferably performed during staging procedures.
Session topic: E-poster
Keyword(s): Hodgkin's lymphoma, Lymphoma therapy, NHL
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