Reproductive outcomes in women with Hodgkin's lymphoma in a Danish fertility preservation cohort.
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INTRODUCTION: The risk of premature ovarian insufficiency (POI) after Hodgkin's lymphoma depends on female age, type, and dose of gonadotoxic treatment. Treatment with ABVD rarely results in POI and impaired fertility, whereas treatment with BEACOPP or stem cell transplantation is associated with higher risks of ovarian failure. Reports on parenthood rates are reassuring, although some studies report reduced fertility after treatment. In this study, we evaluate the reproductive outcomes after Hodgkin's lymphoma and the risk of POI after different types of chemotherapy. MATERIAL AND METHODS: This cohort study was conducted at the Fertility Clinic at Rigshospitalet University Hospital, Copenhagen, Denmark. Data was collected retrospectively from medical records from 1999 to 2020 and prospectively from 2020 to 2023. We included all female patients with Hodgkin's lymphoma, referred for fertility preservation between 1999 and 2022. End of follow-up was December 31, 2023. Information about diagnoses, gonadotoxic treatment, and gynecologic and obstetric history was retrieved from medical records. RESULTS: A total of 59 women were included: 21 received low-dose, 15 moderate-dose, and 20 high-dose chemotherapy (3 unknown). Ovarian tissue cryopreservation (OTC) was done for fertility preservation in 86%. Mean age at diagnosis was 23.9 (SD 4.9) years. While no women developed POI after low-dose chemotherapy, 4 (27%) did after moderate-dose and 10 (50%) after high-dose chemotherapy. Among 38 women with a pregnancy wish, 30 achieved at least one livebirth after cancer. Mean age at first pregnancy was 29.7 (SD 4.0) years. The chance of delivery after high dose was lower compared with low-dose chemotherapy (OR 0.06, 95% CI:0.01-0.68) (p = 0.020). Among 33 women with OTC, 21 achieved pregnancy and delivery without ovarian tissue transplantation (OTT). Nine women underwent OTT of whom four delivered (44%) a total of five children. CONCLUSIONS: The likelihood of livebirth and risk of POI depended on the type of chemotherapy, with the least number of deliveries and the highest risk of POI after high-dose chemotherapy. Pregnancy rates were reassuringly high even among women with a single ovary after OTC, with only 20% returning for OTT. Our findings support that fertility preservation in Hodgkin's lymphoma patients should primarily be offered to those receiving moderate- to high-dose chemotherapy.