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Demeestere I, Racape J, Dechene J, Dupuis J, Morschhauser F, De Wilde V, Lazarovici J, Ghesquieres H, Touati M, Sibon D, Alexis M, Gac AC, Moatti H, Virelizier E, Maisonneuve H, Pranger D, Houot R, Fornecker LM, Tempescul A, André M, Casasnovas RO. Gonadal Function Recovery in Patients With Advanced Hodgkin Lymphoma Treated With a PET-Adapted Regimen: Prospective Analysis of a Randomized Phase III Trial (AHL2011). J Clin Oncol 2021; 39:3251-3260. [PMID: 34156881 DOI: 10.1200/jco.21.00068] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
PURPOSE The prospective, randomized AHL2011 trial demonstrated that the use of the doxorubicin, bleomycin, vinblastine, and dacarbazine regimen (ABVD) after two cycles of bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone (BEACOPPescalated) in early responders on the basis of a positron emission tomography (PET)-driven strategy was safe and minimized toxicity compared with standard 6 BEACOPPescalated cycles. This substudy investigated the benefit of this strategy in gonadal function and fertility in patients under 45 years old. METHODS Ovarian function was assessed by serum measurement of follicle-stimulating hormone (FSH), estradiol, and anti-müllerian hormone in women, and semen analysis, FSH, and testosterone levels were used to evaluate testicular function in men at baseline, end of treatment, and during 5 years of follow-up. RESULTS A total of 145 women and 424 men, enrolled between May 19, 2011, and April 29, 2014, were included. The risk of premature ovarian insufficiency (FSH > 24 IU/L) and of having a low ovarian reserve (anti-müllerian hormone < 0.5 ng/mL) was reduced after treatment in the PET-driven group (odds ratio [OR], 0.20; 95% CI, 0.08 to 0.50; P = .001 and OR, 0.15; 95% CI, 0.04 to 0.56, P = .005, respectively). Both parameters were correlated with age and dose of alkylating agents. However, no significant differences were observed in terms of pregnancy rates. Men in the PET-driven group had a higher recovery rate of sperm parameters after treatment compared with the standard BEACOPPescalated group, as well as a lower risk of severe testicular damage (OR, 0.26; 95% CI, 0.13 to 0.5; P < .0001) and a higher likelihood of achieving pregnancy (OR, 3.7; 95% CI, 1.4 to 9.3; P = .004). CONCLUSION Although both treatments affected ovarian reserve and spermatogenesis, the PET-driven strategy decreased the risk of gonadal dysfunction and infertility in advanced Hodgkin lymphoma.
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Affiliation(s)
- Isabelle Demeestere
- Research Laboratory on Human Reproduction and Fertility Clinic, CUB-Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Judith Racape
- Research Center in Epidemiology, Biostatistics and Clinical Research, School of Public Health, and Biomedical Research Department, CUB-Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Julie Dechene
- Research Laboratory on Human Reproduction, Université Libre de Bruxelles, Brussels, Belgium
| | - Jehan Dupuis
- Department of Haematology, Hopital H. Mondor, Creteil, France
| | - Franck Morschhauser
- Department of Hematology, University of Lille, CHU Lille, EA 7365-GRITA-Groupe de Recherche sur les formes Injectables et les Technologies Associées, Lille, France
| | - Virginie De Wilde
- Department of Haematology, CUB-Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Julien Lazarovici
- Department of Haematology Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - Hervé Ghesquieres
- Department of Haematology, Hospices Civils de Lyon, Centre Hospitalier Lyon-Sud, et Université Claude Bernard Lyon-1, Pierre Bénite, France
| | | | - David Sibon
- Department of Haematology, Hopital Necker, Paris, France
| | - Magda Alexis
- Department of Haematology, CH Orleans, Orleans, France
| | - Anne-Claire Gac
- Department of Haematology, Institut d'hématologie de basse normandie, Caen, France
| | - Hannah Moatti
- Department of Haematology, APHP, Hopital Saint Louis, Paris, France
| | | | - Hervé Maisonneuve
- Department of Haematology, Hopital departemental de Vendée, La Roche sur Yon, France
| | - Delphine Pranger
- Department of Haematology, Grand Hopital de Charleroi, Charleroi, Belgium
| | - Roch Houot
- Department of Hematology, University Hospital of Rennes, Rennes, France
| | | | - Adrian Tempescul
- Department of Hematology, University Hospital of Brest, Brest, France
| | - Marc André
- Department of Haematology, CHU UCL Namur, Université catholique de Louvain, Yvoir, Belgium
| | - René-Olivier Casasnovas
- Department of Haematology, University Hospital F Mitterrand and Inserm UMR1231, Dijon, France
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Jhawar SR, Rivera-Núñez Z, Drachtman R, Cole PD, Hoppe BS, Parikh RR. Association of Combined Modality Therapy vs Chemotherapy Alone With Overall Survival in Early-Stage Pediatric Hodgkin Lymphoma. JAMA Oncol 2020; 5:689-695. [PMID: 30605220 DOI: 10.1001/jamaoncol.2018.5911] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance To date, there is no well-defined standard of care for early-stage pediatric Hodgkin lymphoma (HL), which may include chemotherapy alone or combined modality therapy (CMT) with chemotherapy followed by radiotherapy. Although the use of radiotherapy in pediatric HL is decreasing, this strategy remains controversial. Objective To examine the use of CMT in pediatric HL and its association with improved overall survival using data from a large cancer registry. Design, Setting, and Participants This observational cohort study used data from the National Cancer Database to evaluate clinical features and survival outcomes among 5657 pediatric patients (age, 0.1-21 years) who received a diagnosis of stage I or II HL in the United States from January 1, 2004, to December 31, 2015. Statistical analysis was conducted from May 1 to November 1, 2018. Exposures Patients received definitive treatment with chemotherapy or CMT, defined as chemotherapy followed by radiotherapy. Main Outcomes and Measures Kaplan-Meier survival curves were used to examine overall survival. The association between CMT use, covariables, and overall survival was assessed in multivariable Cox proportional hazards regression models. Use of radiotherapy was assessed over time. Results Among the 11 546 pediatric patients with HL in the National Cancer Database, 5657 patients (3004 females, 2596 males, and 57 missing information on sex; mean [SD] age, 17.1 [3.6] years) with stage I or II classic HL were analyzed. Of these patients, 2845 (50.3%) received CMT; use of CMT vs chemotherapy alone was associated with younger age (<16 years, 1102 of 2845 [38.7%] vs 856 of 2812 [30.4%]; P < .001), male sex (1369 of 2845 [48.1%] vs 1227 of 2812 [43.6%]; P < .001), stage II disease (2467 of 2845 [86.7%] vs 2376 of 2812 [84.5%]; P = .02), and private health insurance (2065 of 2845 [72.6%] vs 1949 of 2812 [69.3%]; P = .002). The 5-year overall survival was 94.5% (confidence limits, 93.8%, 95.8%) for patients who received chemotherapy alone and 97.3% (confidence limits, 96.4%, 97.9%) for those who received CMT, which remained significant in the intention-to-treat analysis and multivariate analysis (adjusted hazard ratio for CMT, 0.57; 95% CI, 0.42-0.78; P < .001). In the sensitivity analysis, the low-risk cohort (stage I-IIA) and adolescent and young adult patients had the greatest benefit from CMT (adjusted hazard ratio, 0.47; 95% CI, 0.40-0.56; P < .001). The use of CMT decreased by 24.8% from 2004 to 2015 (from 59.7% [271 of 454] to 34.9% [153 of 438]). Conclusions and Relevance In this study, pediatric patients with early-stage HL receiving CMT experienced improved overall survival 5 years after treatment. There is a nationwide decrease in the use of CMT, perhaps reflecting the bias of ongoing clinical trials designed to avoid consolidation radiotherapy. This study represents the largest data set to date examining the role of CMT in pediatric HL.
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Affiliation(s)
- Sachin R Jhawar
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick
| | - Zorimar Rivera-Núñez
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick.,Biometrics Division, Rutgers Cancer Institute of New Jersey, New Brunswick.,Department of Biostatistics, Rutgers School of Public Health, New Brunswick, New Jersey
| | - Richard Drachtman
- Section of Pediatric Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick
| | - Peter D Cole
- Section of Pediatric Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick
| | - Bradford S Hoppe
- Department of Radiation Oncology, University of Florida, Gainesville.,University of Florida Health Proton Therapy Institute, Jacksonville
| | - Rahul R Parikh
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick
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Findeklee S, Radosa JC, Takacs Z, Hamza A, Sima R, Solomayer E, Sklavounos P. Fertility preservation in female cancer patients: current knowledge and future perspectives. ACTA ACUST UNITED AC 2019; 71:298-305. [PMID: 30993959 DOI: 10.23736/s0026-4784.19.04387-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Protecting fertility in the presence of cancer has become highly significant, as the desire to give birth to a child is increasingly postponed to later in life, and long-term survival with cancer has increased. A variety of fertility-preserving methods have been developed. EVIDENCE ACQUISITION To find them, we performed a literature search in Medline using the key words "female fertility preservation in cancer" in December 2017. A total of 2381 different publications were found. EVIDENCE SYNTHESIS After screening the abstracts 78 publications in English, French, or German language had been assessed as relevant (17 dealing with medical approaches, six with surgical approaches, 15 with oocyte cryopreservation, 11 with ovarian tissue cryopreservation and 29 were review articles). In general, there are medical (non-surgical) and surgical approaches. Medical approaches comprise administration of GnRH-analogues during gonad toxic oncologic treatment, and cryopreservation of oocytes after ovarian stimulation. Surgical approaches comprise traditional methods of organ-saving surgery and ovarian transposition outside of the radiation portal as well as ovary cryopreservation as standard. CONCLUSIONS It is important to inquire about a prospective desire to have children with premenopausal women with cancer and comprehensively explain the fertility conserving methods available. Every premenopausal woman with cancer should be counseled about the methods of fertility protection currently available at a multiprofessional center.
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Affiliation(s)
- Sebastian Findeklee
- Department of Gynecology, Obstetrics, and Reproductive Medicine, University Hospital of Saarland, Homburg, Germany -
| | - Julia C Radosa
- Department of Gynecology, Obstetrics, and Reproductive Medicine, University Hospital of Saarland, Homburg, Germany
| | - Zoltan Takacs
- Department of Gynecology, Obstetrics, and Reproductive Medicine, University Hospital of Saarland, Homburg, Germany
| | - Amr Hamza
- Department of Gynecology, Obstetrics, and Reproductive Medicine, University Hospital of Saarland, Homburg, Germany
| | - Romina Sima
- Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Erich Solomayer
- Department of Gynecology, Obstetrics, and Reproductive Medicine, University Hospital of Saarland, Homburg, Germany
| | - Panagiotis Sklavounos
- Department of Gynecology, Obstetrics, and Reproductive Medicine, University Hospital of Saarland, Homburg, Germany
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Panjwani AA, Marín-Chollom AM, Pervil IZ, Erblich J, Rubin LR, Schuster MW, Revenson TA. Illness Uncertainties Tied to Developmental Tasks Among Young Adult Survivors of Hematologic Cancers. J Adolesc Young Adult Oncol 2019; 8:149-156. [DOI: 10.1089/jayao.2018.0024] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Aliza A. Panjwani
- Department of Psychology, The Graduate Center & Hunter College, City University of New York, New York, New York
| | | | - Ian Z. Pervil
- The Graduate Center, City University of New York, New York, New York
| | - Joel Erblich
- Department of Psychology, Hunter College & The Graduate Center, City University of New York, New York, New York
| | - Lisa R. Rubin
- Department of Psychology, The New School for Social Research, New York, New York
| | | | - Tracey A. Revenson
- Department of Psychology, Hunter College & The Graduate Center, City University of New York, New York, New York
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Ciavarella S, Minoia C, Quinto AM, Oliva S, Carbonara S, Cormio C, Cox MC, Bravo E, Santoro F, Napolitano M, Spina M, Loseto G, Guarini A. Improving Provision of Care for Long-term Survivors of Lymphoma. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2017; 17:e1-e9. [PMID: 28916153 DOI: 10.1016/j.clml.2017.08.097] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Revised: 07/21/2017] [Accepted: 08/07/2017] [Indexed: 12/11/2022]
Abstract
The progressive improvement of lymphoma therapies has led to a significant prolongation of patient survival and life expectancy. However, lymphoma survivors are at high risk of experiencing a range of early and late adverse effects associated with the extent of treatment exposure. Among these, second malignancies and cardiopulmonary diseases can be fatal, and neurocognitive dysfunction, endocrinopathy, muscle atrophy, and persistent fatigue can affect patients' quality of life for decades after treatment. Early recognition and reduction of risk factors and proper monitoring and treatment of these complications require well-defined follow-up criteria, close coordination among specialists of different disciplines, and a tailored model of survivorship care. We have summarized the major aspects of therapy-related effects in lymphoma patients, reviewed the current recommendations for follow-up protocols, and described a new hospital-based model of survivorship care provision from a recent multicenter Italian experience.
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Affiliation(s)
- Sabino Ciavarella
- Hematology and Cell Therapy Unit, IRCCS-Istituto Tumori "Giovanni Paolo II", Bari, Italy.
| | - Carla Minoia
- Hematology and Cell Therapy Unit, IRCCS-Istituto Tumori "Giovanni Paolo II", Bari, Italy
| | - Angela Maria Quinto
- Hematology and Cell Therapy Unit, IRCCS-Istituto Tumori "Giovanni Paolo II", Bari, Italy
| | - Stefano Oliva
- Cardiology Unit, IRCCS-Istituto Tumori "Giovanni Paolo II", Bari, Italy
| | - Santa Carbonara
- Cardiology Unit, IRCCS-Istituto Tumori "Giovanni Paolo II", Bari, Italy
| | - Claudia Cormio
- Psycho-oncology Service, IRCCS-Istituto Tumori "Giovanni Paolo II", Bari, Italy
| | - Maria Christina Cox
- Hematology Unit, Azienda Ospedaliera-Universitaria "Sant'Andrea", Rome, Italy
| | - Elena Bravo
- Research Coordination and Support Service, Istituto Superiore di Sanità, Rome, Italy
| | - Filippo Santoro
- Research Coordination and Support Service, Istituto Superiore di Sanità, Rome, Italy
| | | | - Michele Spina
- IRCCS-Centro di Riferimento Oncologico di Aviano, Aviano, Italy
| | - Giacomo Loseto
- Hematology and Cell Therapy Unit, IRCCS-Istituto Tumori "Giovanni Paolo II", Bari, Italy
| | - Attilio Guarini
- Hematology and Cell Therapy Unit, IRCCS-Istituto Tumori "Giovanni Paolo II", Bari, Italy
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Sonigo C, Seroka A, Cédrin-Durnerin I, Sermondade N, Sifer C, Grynberg M. History of ABVD alters the number of oocytes vitrified after in vitro maturation in fertility preservation candidates. Future Oncol 2016; 12:1713-9. [PMID: 26960957 DOI: 10.2217/fon-2016-0009] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
AIM This retrospective case-control study aimed at analyzing the results of in vitro maturation (IVM) of oocytes, used for fertility preservation (FP), in patients with history of ABVD (adriamycin, bleomycin, vinblastine and dacarbazine) for classical Hodgkin lymphoma. PATIENTS & METHODS A total of 22 candidates for FP, having received ABVD at least 2 years before IVM for FP were studied. IVM results were compared with those of 44 breast cancer patients, without history of chemotherapy, matched for ovarian reserve parameters. RESULTS The number of cumulo-oocyte complexes recovered and the total number of matured oocytes vitrified was lower in patients having received AVBD (5.5 ± 4.8 vs 8.5 ± 4.4 oocytes; p = 0.03 and 3.5 ± 3.7 vs 6 ± 3.0 oocytes; p < 0.04, respectively). CONCLUSION In light of these results, FP should be discussed before ABVD.
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Affiliation(s)
- Charlotte Sonigo
- Service de Médecine de la Reproduction et Préservation de la Fertilité, Hôpital Jean-Verdier, Avenue du 14 Juillet, 93140 Bondy, France.,Université Paris XIII, 93000 Bobigny, France
| | - Alice Seroka
- Service de Médecine de la Reproduction et Préservation de la Fertilité, Hôpital Jean-Verdier, Avenue du 14 Juillet, 93140 Bondy, France
| | - Isabelle Cédrin-Durnerin
- Service de Médecine de la Reproduction et Préservation de la Fertilité, Hôpital Jean-Verdier, Avenue du 14 Juillet, 93140 Bondy, France
| | - Nathalie Sermondade
- Service de Cytogénétique et Biologie de la Reproduction, Hôpital Jean-Verdier, Avenue du 14 Juillet, 93140 Bondy, France
| | - Christophe Sifer
- Service de Cytogénétique et Biologie de la Reproduction, Hôpital Jean-Verdier, Avenue du 14 Juillet, 93140 Bondy, France
| | - Michael Grynberg
- Service de Médecine de la Reproduction et Préservation de la Fertilité, Hôpital Jean-Verdier, Avenue du 14 Juillet, 93140 Bondy, France.,Université Paris XIII, 93000 Bobigny, France.,Unité Inserm U1133, Université Paris-Diderot, 75013 Paris, France
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7
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Boltežar L, Pintarić K, Jezeršek Novaković B. Fertility in young patients following treatment for Hodgkin's lymphoma: a single center survey. J Assist Reprod Genet 2015; 33:325-333. [PMID: 26678493 PMCID: PMC4785158 DOI: 10.1007/s10815-015-0636-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2015] [Accepted: 12/08/2015] [Indexed: 11/28/2022] Open
Abstract
Purpose The purpose of this study was to determine the fertility rates following treatment by means of the BEACOPP regimen (regular and escalated) (bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, prednisone) as compared to the ABVD regimen (doxorubicin, vinblastine, dacarbazine, bleomycin) in Hodgkin lymphoma patients under the age of 40 at the time of treatment. Methods A questionnaire was sent to 180 Hodgkin lymphoma (HL) patients. The questionnaire was composed of questions concerning reproduction and also menopausal and aging symptoms in females and males. The analyses were made using data collected from 123 patients (76 females and 47 males) who returned the questionnaire. All of the patients were treated between 1999 and 2012. Results In comparing the ABVD and BEACOPP groups of female patients, the frequency of the therapy-induced amenorrhea and the restored menses following treatment were found to be significantly different statistically (p = 0.002 and p = 0.012, respectively). The secondary amenorrhea statistically appeared more often in the BEACOPP group (p = 0.003) while the cases of achieving pregnancy and having children after chemotherapy were not significantly different (p = 0.630, p = 0.070, respectively). In comparing the ABVD and BEACOPP treatments in male patients, the only significant difference was in the number of artificially inseminated or in vitro pregnancies achieved in the BEACOPP and escalated BEACOPP group, p = 0.008 and p = 0.002, respectively. In total, 45.2 % of patients in the ABVD female group, 34.6 % in the BEACOPP female group, 52.6 % in the ABVD male group, and 33.3 % in the male BEACOPP group, respectively, of patients attempting conception post-therapy, had children after chemotherapy. Conclusions Based on these high rates of childbirth following BEACOPP chemotherapy, we have concluded that intensified chemotherapy is not a definite predictor of reduced fertility in young HL patients.
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Affiliation(s)
- Lučka Boltežar
- Department of Medical Oncology, Institute of Oncology Ljubljana, Zaloška 2, 1000, Ljubljana, Slovenia
| | - Karlo Pintarić
- Faculty of Medicine, University of Ljubljana, Vrazov trg 2, 1000, Ljubljana, Slovenia
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Giulino-Roth L, Keller FG, Hodgson DC, Kelly KM. Current approaches in the management of low risk Hodgkin lymphoma in children and adolescents. Br J Haematol 2015; 169:647-60. [PMID: 25824371 DOI: 10.1111/bjh.13372] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
The outcome for children and adolescents with low risk Hodgkin lymphoma (HL) is excellent, with event-free survival >85% and overall survival >95%. Historically, however, treatment has come at the cost of significant long-term toxicity from chemotherapy, radiation or a combination of these. Recent treatment strategies have focused on maintaining high event-free and overall survival while minimizing the use of therapy associated with late effects. The strategies used to achieve this vary greatly among paediatric cooperative groups and there is no one standard treatment for children with low risk HL. This review summaries recent clinical trials in paediatric low risk HL and addresses some of the important considerations when comparing trials, including differences in the definition of low risk HL, differences in outcome among histological subtypes and varying approaches to reduce or eliminate radiation therapy. Recommendations are provided for the treatment of children with low risk HL outside the setting of a clinical trial.
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Affiliation(s)
- Lisa Giulino-Roth
- Department of Pediatrics, Weill Cornell Medical College, New York, NY, USA.,Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Frank G Keller
- Department of Pediatrics, Aflac Cancer and Blood Disorders Center, Emory University, Atlanta, GA, USA
| | - David C Hodgson
- Radiation Medicine Program, Princess Margaret Cancer Center, Toronto, ON, USA
| | - Kara M Kelly
- Division of Pediatric Hematology/Oncology/Stem Cell Transplant, Department of Pediatrics, Columbia University Medical Center, New York, NY, USA
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9
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Factors associated with pregnancy attempts among female young adult cancer survivors. J Cancer Surviv 2014; 8:571-9. [PMID: 24859010 DOI: 10.1007/s11764-014-0369-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2014] [Accepted: 05/05/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE Little is known about pregnancy attempts among female young cancer survivors (YCS). We sought to determine fertility preservation (FP), demographic, cancer, and reproductive characteristics associated with pregnancy attempts after cancer. METHODS We recruited 251 female YCS (ages 18-44) to complete a survey on reproductive health outcomes. We used log-binomial regression models to estimate relative risks (RR) for characteristics associated with pregnancy attempts. RESULTS For the entire cohort, median time since cancer diagnosis was 2.4 years (interquartile range 4.0). Fifty-two YCS (21%) attempted pregnancy after cancer diagnosis. In unadjusted analyses, lack of FP therapy prior to cancer treatment, older age, partnered relationship, higher income, no history of stem cell or bone marrow transplant, and longer duration of survivorship were significantly associated with pregnancy attempts. In multivariable analyses, YCS who did not undergo FP therapy were more than twice as likely to attempt pregnancy as those who did undergo FP therapy (RR 2.4, 95% confidence interval (CI) 1.3, 4.3). Partnered status (RR 7.1, 95% CI 2.5, 20.2) and >2 years since cancer diagnosis (RR 2.3, 95% CI 1.3, 4.1) were also significantly associated with attempts. CONCLUSIONS In YCS, milestones including partnered relationships and longer duration of cancer survivorship are important to attempting pregnancy. A novel, inverse association between FP therapy and pregnancy attempts warrants further study. IMPLICATIONS FOR CANCER SURVIVORS Pregnancy attempts after cancer were more likely after attaining both social- and cancer-related milestones. As these milestones require time, YCS should be made aware of their potential for concomitant, premature loss of fertility in order to preserve their range of fertility options.
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Navve D, Kaidar-Person O, Keidar Z. Physiological 18F-FDG uptake patterns in female reproductive organs before and after chemotherapy treatments: assessment by PET/CT. Med Oncol 2013; 30:598. [DOI: 10.1007/s12032-013-0598-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2013] [Accepted: 04/27/2013] [Indexed: 10/26/2022]
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