Advertisement

Pregnancy rate and outcome of pregnancies in long-term survivors of Hodgkin’s lymphoma

  • Francesco GaudioEmail author
  • Claudia Nardelli
  • Paola Masciandaro
  • Tommasina Perrone
  • Filomena Emanuela Laddaga
  • Paola Curci
  • Raffaella Depalo
  • Ettore Cicinelli
  • Giorgina Specchia
Original Article

Abstract

Thanks to the increased number of young survivors of Hodgkin’s lymphoma (HL), management of the pregnancies of women who have a history of exposure to chemotherapies and radiation therapy is becoming increasingly common. Many patients and clinicians are worried that pregnancy after the diagnosis of HL may increase the risk of relapse, despite a lack of empirical evidence to support such concerns. In the present study, we included 89 women diagnosed with HL between 2006 and 2015 under the age of 50 years, who were in complete remission and alive without relapse > 1 year after treatment. We determined the pregnancy rate, time to pregnancy, and the disease-free survival. We found no evidence of significant impairment of the fertility of female HL long-term survivors and no evidence that a pregnancy increases the relapse rate among women in remission from HL. Survivors of HL need to consider a range of factors when deciding on future reproduction.

Keywords

Fertility Pregnancy Hodgkin 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

This article does not contain any studies with animals performed by any of the authors.

Informed consent was obtained from all individual participants included in the study.

References

  1. 1.
    Sutton PD, Mathews TJ (2004) National vital statistics report. Trends in characteristics of births by state: United States, 1990, 1995, and 2000–2002, vol 52, p 19Google Scholar
  2. 2.
    Sleebos JE (2003) Low fertility rates in OECD countries: facts and policy responses. organisation for economic co-operation and development, ParisGoogle Scholar
  3. 3.
    Gaudio F, Giordano A, Pavone V, Perrone T, Curci P, Pastore D, Delia M, De’ Risi C, Spina A, Liso V, Specchia G (2011) Outcome of very late relapse in patients with Hodgkin’s lymphomas. Adv Hematol 2011:707542CrossRefGoogle Scholar
  4. 4.
    Behringer K, Mueller H, Goergen H, Thielen I, Eibl AD, Stumpf V, Wessels C, Wiehlpütz M, Rosenbrock J, Halbsguth T, Reiners KS, Schober T, Renno JH, von Wolff M, van der Ven K, Kuehr M, Fuchs M, Diehl V, Engert A, Borchmann P (2013) Gonadal function and fertility in survivors after Hodgkin lymphoma treatment within the German Hodgkin Study Group HD13 to HD15 trials. J Clin Oncol 31:231–239CrossRefGoogle Scholar
  5. 5.
    Barry RM, Diamond HD, Craver LF (1962) Influence of pregnancy on the course of Hodgkin’s disease. Am J Obstet Gynecol 84:445–454CrossRefGoogle Scholar
  6. 6.
    Gobbi PG, Attardo-Parrinello A, Danesino M, Motta C, di Prisco AU, Rizzo SC, Ascari E (1984) Hodgkin’s disease and pregnancy. Haematologica 69:336–341Google Scholar
  7. 7.
    Lishner M, Zemlickis D, Degendorfer P, Panzarella T, Sutcliffe SB, Koren G (1992) Maternal and foetal outcome following Hodgkin’s disease in pregnancy. Br J Cancer 65:114–117CrossRefGoogle Scholar
  8. 8.
    Ruocco MG, Chaouat G, Florez L et al (2014) Regulatory T-cells in pregnancy: historical perspective, state of the art, and burning questions. Front Immunol 5:389CrossRefGoogle Scholar
  9. 9.
    Kushekhar K, van den Berg A, Nolte I, Hepkema B, Visser L, Diepstra A (2014) Genetic associations in classical hodgkin lymphoma: a systematic review and insights into susceptibility mechanisms. Cancer Epidemiol Biomark Prev 23:2737–2747CrossRefGoogle Scholar
  10. 10.
    Liu Y, Sattarzadeh A, Diepstra A, Visser L, van den Berg A (2014) The microenvironment in classical Hodgkin lymphoma: an actively shaped and essential tumor component. Semin Cancer Biol 24:15–22CrossRefGoogle Scholar
  11. 11.
    Gaudio F, Perrone T, Mestice A, Curci P, Giordano A, Delia M, Pastore D, Specchia G (2014 Jul) Peripheral blood CD4/CD19 cell ratio is an independent prognostic factor in classical Hodgkin lymphoma. Leuk Lymphoma 55(7):1596–1601CrossRefGoogle Scholar
  12. 12.
    Leber A, Teles A, Zenclussen AC (2010) Regulatory T cells and their role in pregnancy. Am J Reprod Immunol 63:445–459CrossRefGoogle Scholar
  13. 13.
    Behringer K, Breuer K, Reineke T, May M, Nogova L, Klimm B, Schmitz T, Wildt L, Diehl V, Engert A, German Hodgkin’s Lymphoma Study Group (2005) Secondary amenorrhea after Hodgkin’s lymphoma is influenced by age at treatment, stage of disease, chemotherapy regimen, and the use of oral contraceptives during therapy: a report from the German Hodgkin’s Lymphoma Study Group. J Clin Oncol 23(30):7555–7564CrossRefGoogle Scholar
  14. 14.
    Blumenfeld Z, Dann E, Avivi I, Epelbaum R, Rowe JM (2002) Fertility after treatment for Hodgkin’s disease. Ann Oncol 13(Suppl. 1):138–147CrossRefGoogle Scholar
  15. 15.
    Howell S, Shalet S (1998) Gonadal damage from chemotherapy and radiotherapy. Endocrinol Metab Clin N Am 27(4):927–943CrossRefGoogle Scholar
  16. 16.
    Whitehead E, Shalet SM, Blackledge G, Todd I, Crowther D, Beardwell CG (1983) The effect of combination chemotherapy on ovarian function in women treated for Hodgkin’s disease. Cancer 52(6):988–993CrossRefGoogle Scholar
  17. 17.
    Bokemeyer C, Schmoll HJ, van Rhee J, Kuczyk M, Schuppert F, Poliwoda H (1994) Long-term gonadal toxicity after therapy for Hodgkin’s and non-Hodgkin’s lymphoma. Ann Hematol 68(3):105–110CrossRefGoogle Scholar
  18. 18.
    Viviani S, Santoro A, Ragni G, Bonfante V, Bestetti O, Bona- donna G (1985) Gonadal toxicity after combination chemotherapy for Hodgkin’s disease. Comparative results of MOPP vs ABVD. Eur J Cancer Clin Oncol 21(5):601–605CrossRefGoogle Scholar
  19. 19.
    Anselmo AP, Cartoni C, Bellantuono P, Maurizi-Enrici R, Aboulkair N, Ermini M (1990) Risk of infertility in patients with Hodgkin’s disease treated with ABVD vs MOPP vs ABVD/ MOPP. Haematologica 75(2):155–158Google Scholar
  20. 20.
    Brusamolino E, Lunghi F, Orlandi E, Astori C, Passamonti F, Baraté C, Pagnucco G, Baio A, Franchini P, Lazzarino M, Bernasconi C (2000) Treatment of early- stage Hodgkin’s disease with four cycles of ABVD followed by adjuvant radio- therapy: analysis of efficacy and long-term toxicity. Haematologica 85(10):1032–1039Google Scholar
  21. 21.
    Andre M, Brice P, Cazals D et al (1997) Results of three courses of adriamycin, bleomycin, vindesine, and dacarbazine with subtotal nodal irradiation in 189 patients with nodal Hodgkin’s disease (stage I, II and IIIA). Hematol Cell Ther 39(2):59–65CrossRefGoogle Scholar
  22. 22.
    van der Kaaij MA, Heutte N, Meijnders P et al (2012) Parenthood in survivors of Hodgkin lymphoma: an EORTC-GELA general population case-control study. J Clin Oncol 30:3854–3863CrossRefGoogle Scholar
  23. 23.
    Stensheim H, Cvancarova M, Møller B, Fosså SD (2011) Pregnancy after adolescent and adult cancer: a population-based matched cohort study. Int J Cancer 129:1225–1236CrossRefGoogle Scholar
  24. 24.
    Bonadonna G, Santoro A, Viviani S, Lombardi C, Ragni G (1984) Gonadal damage in Hodgkin’s disease from cancer chemotherapeutic regimens. Arch Toxicol Suppl 7:140–145CrossRefGoogle Scholar
  25. 25.
    Hodgson DC, Pintilie M, Gitterman L, DeWitt B, Buckley CA, Ahmed S, Smith K, Schwartz A, Tsang RW, Crump M, Wells W, Sun A, Gospodarowicz MK (2007) Fertility among female hodgkin lymphoma survivors attempting pregnancy following ABVD chemotherapy. Hematol Oncol 25:11–15CrossRefGoogle Scholar
  26. 26.
    Faddy MJ, Gosden RG, Gougeon A, Richardson SJ, Nelson JF (1992) Accelerated disappearance of ovarian follicles in midlife: implications for forecasting menopause. Hum Reprod 7:1342–1346CrossRefGoogle Scholar
  27. 27.
    Jouet JP, Buchet-Bouverne B, Fenaux P et al (1988) Influence of pregnancy on the development of Hodgkin’s disease. Presse Med 17:423–427Google Scholar
  28. 28.
    Weibull CE, Eloranta S, Smedby KE, Björkholm M, Kristinsson SY, Johansson AL, Dickman PW, Glimelius I (2016 Feb 1) Pregnancy and the risk of relapse in patients diagnosed with Hodgkin lymphoma. J Clin Oncol 34(4):337–344CrossRefGoogle Scholar
  29. 29.
    Lambe M, Hsieh CC, Tsaih SW et al (1998) Childbearing and the risk of Hodgkin’s disease. Cancer Epidemiol Biomark Prev 7:831–834Google Scholar
  30. 30.
    Møller H, Purushotham A, Linklater KM, Garmo H, Holmberg L, Lambe M, Yallop D, Devereux S (2013) Recent childbirth is an adverse prognostic factor in breast cancer and melanoma, but not in Hodgkin lymphoma. Eur J Cancer 49:3686–3693CrossRefGoogle Scholar
  31. 31.
    Stensheim H, Møller B, van Dijk T, Fosså SD (2009) Cause-specific survival for women diagnosed with cancer during pregnancy or lactation: a registry- based cohort study. J Clin Oncol 27:45–51CrossRefGoogle Scholar
  32. 32.
    Sankila R, Heinävaara S, Hakulinen T (1994) Survival of breast cancer patients after subsequent term pregnancy: “healthy mother effect”. Am J Obstet Gynecol 170:818–823CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Francesco Gaudio
    • 1
    Email author
  • Claudia Nardelli
    • 2
  • Paola Masciandaro
    • 2
  • Tommasina Perrone
    • 1
  • Filomena Emanuela Laddaga
    • 3
  • Paola Curci
    • 1
  • Raffaella Depalo
    • 2
  • Ettore Cicinelli
    • 2
  • Giorgina Specchia
    • 1
  1. 1.Department of Emergency and Organ Transplantation (D.E.T.O.), Hematology SectionUniversity of BariBariItaly
  2. 2.Department of Biomedical Science and Human Oncology, Obstetrics and Gynecology UnitUniversity of BariBariItaly
  3. 3.Department of Emergency and Organ Transplantation (D.E.T.O.), Pathology SectionUniversity of BariBariItaly

Personalised recommendations