Caroline E Weibull1, Sandra Eloranta2, Karin E Smedby2, Magnus Björkholm2, Sigurdur Y Kristinsson2, Anna L V Johansson2, Paul W Dickman2, Ingrid Glimelius2. 1. Caroline E. Weibull, Sandra Eloranta, Karin E. Smedby, Anna L.V. Johansson, Paul W. Dickman, and Ingrid Glimelius, Karolinska Institutet; Karin E. Smedby, Magnus Björkholm, Sigurdur Y. Kristinsson, and Ingrid Glimelius, Karolinska University Hospital Solna, Stockholm; Ingrid Glimelius, Uppsala University, Uppsala, Sweden; and Sigurdur Y. Kristinsson, University of Iceland, Reykjavik, Iceland. caroline.weibull@ki.se. 2. Caroline E. Weibull, Sandra Eloranta, Karin E. Smedby, Anna L.V. Johansson, Paul W. Dickman, and Ingrid Glimelius, Karolinska Institutet; Karin E. Smedby, Magnus Björkholm, Sigurdur Y. Kristinsson, and Ingrid Glimelius, Karolinska University Hospital Solna, Stockholm; Ingrid Glimelius, Uppsala University, Uppsala, Sweden; and Sigurdur Y. Kristinsson, University of Iceland, Reykjavik, Iceland.
Abstract
PURPOSE: Many patients and clinicians are worried that pregnancy after the diagnosis of Hodgkin lymphoma (HL) may increase the risk of relapse despite a lack of empirical evidence to support such concerns. We investigated if an association exists between pregnancy and relapse in women with a diagnosis of HL. MATERIALS AND METHODS: Using Swedish healthcare registers combined with medical records, we included 449 women who received a diagnosis of HL between 1992 and 2009 and who were age 18 to 40 years at diagnosis. Follow-up started 6 months after diagnosis, when the patients' condition was assumed to be in remission. Pregnancy-associated relapse was defined as a relapse during pregnancy or within 5 years after delivery. Hazard ratios (HRs) with 95% CIs were estimated by using the Cox proportional hazards model. RESULTS: Among the 449 women, 144 (32%) became pregnant during follow-up. Overall, 47 relapses were recorded, of which one was a pregnancy-associated relapse. The adjusted HR for the comparison of the pregnancy-associated relapse rate to the non-pregnancy-associated relapse rate was 0.29 (95% CI, 0.04 to 2.18). The expected number of relapses in women with a recent pregnancy, given that they would experience the same relapse rate as that of women without a recent pregnancy, was 3.76; the observed-to-expected ratio was 0.27 (95% exact CI, 0.01 to 1.51). CONCLUSION: We found no evidence that a pregnancy after diagnosis increases the relapse rate among women whose HL is in remission. Survivors of HL need to consider a range of factors when deciding about future reproduction. However, given the results of this study, the risk of pregnancy-associated relapse does not need to be considered.
PURPOSE: Many patients and clinicians are worried that pregnancy after the diagnosis of Hodgkin lymphoma (HL) may increase the risk of relapse despite a lack of empirical evidence to support such concerns. We investigated if an association exists between pregnancy and relapse in women with a diagnosis of HL. MATERIALS AND METHODS: Using Swedish healthcare registers combined with medical records, we included 449 women who received a diagnosis of HL between 1992 and 2009 and who were age 18 to 40 years at diagnosis. Follow-up started 6 months after diagnosis, when the patients' condition was assumed to be in remission. Pregnancy-associated relapse was defined as a relapse during pregnancy or within 5 years after delivery. Hazard ratios (HRs) with 95% CIs were estimated by using the Cox proportional hazards model. RESULTS: Among the 449 women, 144 (32%) became pregnant during follow-up. Overall, 47 relapses were recorded, of which one was a pregnancy-associated relapse. The adjusted HR for the comparison of the pregnancy-associated relapse rate to the non-pregnancy-associated relapse rate was 0.29 (95% CI, 0.04 to 2.18). The expected number of relapses in women with a recent pregnancy, given that they would experience the same relapse rate as that of women without a recent pregnancy, was 3.76; the observed-to-expected ratio was 0.27 (95% exact CI, 0.01 to 1.51). CONCLUSION: We found no evidence that a pregnancy after diagnosis increases the relapse rate among women whose HL is in remission. Survivors of HL need to consider a range of factors when deciding about future reproduction. However, given the results of this study, the risk of pregnancy-associated relapse does not need to be considered.
Authors: R Troisi; T Bjørge; M Gissler; T Grotmol; C M Kitahara; S M Myrtveit Saether; A G Ording; C Sköld; H T Sørensen; B Trabert; I Glimelius Journal: J Intern Med Date: 2018-03-25 Impact factor: 8.989
Authors: Ingrid Glimelius; Annika Englund; Klaus Rostgaard; Karin E Smedby; Sandra Eloranta; Peter de Nully Brown; Christoffer Johansen; Peter Kamper; Gustaf Ljungman; Lisa Lyngsie Hjalgrim; Henrik Hjalgrim Journal: Cancer Med Date: 2019-07-02 Impact factor: 4.452