Contributions
Abstract: EP1184
Type: E-Poster Presentation
Session title: Quality of life, palliative care, ethics and health economics
Background
In the last decades, a significant improvement in overall survival (OS) of patients (Pts) affected by lymphoma has been observed. Fertility and gonadal function represent one of the most important aspects for long-term lymphoma survivors.
Aims
We designed this retrospective, multicentric, observational study, with the primary end point to describe the application in real-life of different methods of fertility preservation during treatment in lymphoma pts afferent to the Fondazione Italiana Linfomi (FIL) centers participating. Other end points were: to determine amenorrhea rate after first and subsequent lines of treatment and possible risk factors in young female lymphoma patients and to record rate of pregnancy and miscarriage after treatment in this population.
Methods
All female pts, aged from 18 to 40 years old, diagnosed with Hodgkin (HL) or non-Hodgkin’s lymphoma (NHL) in the timeframe between Oct 1st/2010 and May 31st/2018, treated with chemoimmunotherapy (CHT) regimens and/or radiotherapy (RT) were included in the analysis. Histology included were: HL, primary mediastinal B-cell (PMBCL), diffuse large B-cell (DLBCL), follicular (FL), mantle cell (MCL) and T-cell Lymphoma.
Results
A total of 414 women were enrolled in the study. Median age was 28 years old (range 18-40), histology were: HL 308 (74%), PMBCL 56 (13%), DLBCL 43 (10%), FL plus MCL plus T-cell lymphoma 7 (3%). Advanced Ann Arbor stage III-IV was seen in 164 (40%) of pts. First line treatment were: ABVD in 295 (71%), R-CHOP like in 102 (25%), higher intensity regimens (BEACOPP/high dose chemotherapy plus autologous stem cell transplantation (ASCT) in 17 (4%) cases. 203 (49%) patients received RT. A relapsed/refractory disease was observed in 48 (11%) cases, and 52% of them received ASCT. Pretreatment data recorded: regular period in 80%, previous pregnancy in 26%, previous miscarriage in 9%. Overall, 76% of the ptsreceived GnRH analogues during chemotherapy; 10% took OCs and 14% nothing. Oocytes and ovarian tissue cryopreservation were performed in 55 and 42 pts, respectively (23%). In 7 pts were proposed with cryopreservation but not performed for therapy urgency. Post treatment data were transient amenorrhea in 216 (75%), premature ovarian failure (POF) in 33 (9%), a restored regular period was observed in 293 (90%) on cases. After treatment were recorded 43 (10%) pregnancies and 17 (4%) miscarriages. Most pregnancies (88%) were observed in women under 30 years of age and subjected to a single line of therapy. Median age of menopause onset was 34.5 ± 7.8 years old (19.0-47.0). In multivariate analysis median age at diagnosis and number of lines of treatment correlate with higher rate of amenorrhea, risk of POF and menopause. No protective effect of GnRHa administration of amenorrhea, POF and menopause was observed. Even if 23% of pts performed oocytes and ovarian tissue cryopreservation, this was not used in any case.
Conclusion
Pregnancy in long term lymphoma survivors should be considered possible and safe. Median age at diagnosis and number of treatment lines correlate with amenorrhea, POF rate and menopause. The use of GnRHa and OCs not seem protective for fertility. Our study confirm the need to a correct and multidisciplinary approach to fertility preservation in young lymphoma patients for a correct strategy in relation to the patient's age, type of disease and chemotherapy treatment
Keyword(s): Fertility, Lymphoma therapy, Pregnancy
Abstract: EP1184
Type: E-Poster Presentation
Session title: Quality of life, palliative care, ethics and health economics
Background
In the last decades, a significant improvement in overall survival (OS) of patients (Pts) affected by lymphoma has been observed. Fertility and gonadal function represent one of the most important aspects for long-term lymphoma survivors.
Aims
We designed this retrospective, multicentric, observational study, with the primary end point to describe the application in real-life of different methods of fertility preservation during treatment in lymphoma pts afferent to the Fondazione Italiana Linfomi (FIL) centers participating. Other end points were: to determine amenorrhea rate after first and subsequent lines of treatment and possible risk factors in young female lymphoma patients and to record rate of pregnancy and miscarriage after treatment in this population.
Methods
All female pts, aged from 18 to 40 years old, diagnosed with Hodgkin (HL) or non-Hodgkin’s lymphoma (NHL) in the timeframe between Oct 1st/2010 and May 31st/2018, treated with chemoimmunotherapy (CHT) regimens and/or radiotherapy (RT) were included in the analysis. Histology included were: HL, primary mediastinal B-cell (PMBCL), diffuse large B-cell (DLBCL), follicular (FL), mantle cell (MCL) and T-cell Lymphoma.
Results
A total of 414 women were enrolled in the study. Median age was 28 years old (range 18-40), histology were: HL 308 (74%), PMBCL 56 (13%), DLBCL 43 (10%), FL plus MCL plus T-cell lymphoma 7 (3%). Advanced Ann Arbor stage III-IV was seen in 164 (40%) of pts. First line treatment were: ABVD in 295 (71%), R-CHOP like in 102 (25%), higher intensity regimens (BEACOPP/high dose chemotherapy plus autologous stem cell transplantation (ASCT) in 17 (4%) cases. 203 (49%) patients received RT. A relapsed/refractory disease was observed in 48 (11%) cases, and 52% of them received ASCT. Pretreatment data recorded: regular period in 80%, previous pregnancy in 26%, previous miscarriage in 9%. Overall, 76% of the ptsreceived GnRH analogues during chemotherapy; 10% took OCs and 14% nothing. Oocytes and ovarian tissue cryopreservation were performed in 55 and 42 pts, respectively (23%). In 7 pts were proposed with cryopreservation but not performed for therapy urgency. Post treatment data were transient amenorrhea in 216 (75%), premature ovarian failure (POF) in 33 (9%), a restored regular period was observed in 293 (90%) on cases. After treatment were recorded 43 (10%) pregnancies and 17 (4%) miscarriages. Most pregnancies (88%) were observed in women under 30 years of age and subjected to a single line of therapy. Median age of menopause onset was 34.5 ± 7.8 years old (19.0-47.0). In multivariate analysis median age at diagnosis and number of lines of treatment correlate with higher rate of amenorrhea, risk of POF and menopause. No protective effect of GnRHa administration of amenorrhea, POF and menopause was observed. Even if 23% of pts performed oocytes and ovarian tissue cryopreservation, this was not used in any case.
Conclusion
Pregnancy in long term lymphoma survivors should be considered possible and safe. Median age at diagnosis and number of treatment lines correlate with amenorrhea, POF rate and menopause. The use of GnRHa and OCs not seem protective for fertility. Our study confirm the need to a correct and multidisciplinary approach to fertility preservation in young lymphoma patients for a correct strategy in relation to the patient's age, type of disease and chemotherapy treatment
Keyword(s): Fertility, Lymphoma therapy, Pregnancy