The impact of conventional and high-dose therapy for lymphoma on fertility.

The impact of chemotherapy on gonadal function is an important issue for younger patients surviving lymphoma. This article reviews the effects on fertility of conventional and intensive-dose chemotherapy regimens with or without radiation therapy. In general, conventional dose regimens such as ABVD (doxorubicin/bleomycin/vinblastine/decarbazine) and CHOP21 (cyclophosphamide/doxorubicin/vincristine/prednisone) are not sterilizing, but data are limited on the effects of newer aggressive regimens such as BEACOPP (bleomycin/etoposide/doxorubicin/cyclophosphamide/vincristine/procarbazine/prednisone), CHOP14, and CHOP/etoposide. Infertility after myeloablative transplant conditioning is common but not invariable. The role of prechemotherapy gonadotrophin-releasing hormone agonists and antagonists for the prevention of gonadal damage is under evaluation. In addition, new techniques for sperm and oocyte retrieval offer the prospect of improved fertility after sterilizing treatment. Management guidelines for patients undergoing nonmyeloblative and myeloablative therapy are presented, addressing additional issues such as contraception during and after the administration of cytotoxics and the importance of gynecologic and endocrine follow-up in determining the need for short- and long-term hormone replacement therapy.