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Impact of ABVD chemotherapy on ovarian reserve after fertility preservation in reproductive-aged women with Hodgkin lymphoma

Abstract

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.

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Fig. 1

Abbreviations

ABVD:

Adriamycin, bleomycin, vinblastine, and dacarbazine

AFC:

Antral follicle count

AMH:

Anti-Müllerian hormone

CT:

Chemotherapy

FP:

Fertility preservation

HL:

Hodgkin lymphoma

HSCT:

Hematopoietic stem cell transplant

POF:

Premature ovarian failure

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Acknowledgments

We would like to thank Dr César Díaz-García for his invaluable contribution to the design of this study.

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Correspondence to Jessica Subirá.

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The authors declare that they have no conflict of interest.

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Catarina Policiano and Jessica Subirá are joint first authors.

Key message

ABVD treatment for HL reduces ovarian reserve compared with normal population. The technique used for FP does not seem to have an impact on ovarian reserve parameters. This information and its potential consequences on future fertility should be considered when counseling HL patients before FP.

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Policiano, C., Subirá, J., Aguilar, A. et al. Impact of ABVD chemotherapy on ovarian reserve after fertility preservation in reproductive-aged women with Hodgkin lymphoma. J Assist Reprod Genet 37, 1755–1761 (2020). https://doi.org/10.1007/s10815-020-01844-0

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Keywords

  • Fertility preservation
  • Hodgkin lymphoma
  • Ovarian reserve
  • ABVD
  • Anti-Müllerian hormone