Research question

How is ovarian reserve affected by chemotherapy in patients with Hodgkin lymphoma (HL) who undergo fertility preservation (FP)?

Methods

A retrospective study was conducted by reviewing medical records of 105 HL patients referred to the FP unit before starting adriamycin, bleomycin, vinblastine, and dacarbazine (ABVD) chemotherapy. Ovarian reserve was evaluated before chemotherapy and at the last follow-up using anti-Müllerian hormone (AMH) and antral follicle count (AFC) measurements. The decrease in AMH was compared with that expected from normograms. AMH was compared between patients who underwent cryopreservation of ovarian tissue and those who underwent cryopreservation of mature oocytes.

Results

After ABVD, 15% of patients required hematopoietic stem cell transplantation. At a median follow-up of 33 months, the median decrease in AMH was 0.88 ng/mL, which was significantly greater than that of the general population of this age group (p < 0.001). Of the 82 women who only had ABVD, 38 underwent FP by cryopreservation of mature oocytes and 44 underwent cryopreservation of the ovarian cortex. There was no significant difference in AMH or AFC at the last follow-up between FP techniques.

Conclusion

Although ABVD is considered to be of low gonadotoxic risk, the decrease in AMH was greater than expected for patients’ age, and 15% of patients needed more aggressive therapy during follow-up. Type of FP was not associated with decline in ovarian reserve. Reproductive-aged women with HL should have the opportunity for FP counseling before starting treatment.

中文翻译：

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霍奇金淋巴瘤育龄妇女生育后保留ABVD化疗对卵巢储备的影响。

研究问题

接受生育力保存（FP）的霍奇金淋巴瘤（HL）患者的化疗对卵巢储备有何影响？

方法

回顾性研究通过回顾105例在开始阿霉素，博来霉素，长春碱和达卡巴嗪（ABVD）化疗前转诊至FP病房的HL患者的病历来进行。在化疗之前和最后一次随访中，使用抗苗勒氏激素（AMH）和肛门卵泡计数（AFC）测量来评估卵巢储备。将AMH的下降与正常值的预期值进行了比较。比较了接受冷冻保存卵巢组织的患者和接受冷冻保存成熟卵母细胞的患者的AMH。

结果

ABVD后，15％的患者需要造血干细胞移植。在中位随访33个月时，AMH的中位下降为0.88 ng / mL，明显高于该年龄段的一般人群（p  <0.001）。在仅患有ABVD的82例女性中，有38例通过冷冻保存成熟的卵母细胞进行了FP，44例进行了卵巢皮质冷冻保存。在最后一次随访中，FP技术之间的AMH或AFC没有显着差异。

结论

尽管ABVD被认为具有较低的性腺毒性风险，但AMH的下降幅度超过了患者年龄的预期，并且15％的患者在随访期间需要更积极的治疗。FP类型与卵巢储备下降无关。HL育龄妇女在开始治疗之前应有机会进行FP咨询。