Isabelle Demeestere1, Pauline Brice2, Fedro A Peccatori2, Alain Kentos2, Jehan Dupuis2, Pierre Zachee2, Olivier Casasnovas2, Eric Van Den Neste2, Julie Dechene2, Viviane De Maertelaer2, Dominique Bron2, Yvon Englert2. 1. Isabelle Demeestere, Julie Dechene, Yvon Englert, and Viviane De Maertelaer, Université Libre de Bruxelles; Alain Kentos and Yvon Englert, Erasme Hospital; Eric Van Den Neste, Cliniques Universitaires UCL Saint-Luc; Dominique Bron, J. Bordet Institute, Brussels; Pierre Zachee, Algemeen Ziekenhuis Stuivenberg, Antwerpen, Belgium; Pauline Brice, St Louis Hospital, APHP; Jehan Dupuis, Hôpital Henri Mondor, Paris; Olivier Casasnovas, CHU de Dijon, Dijon, France; and Fedro A. Peccatori, Istituto Europeo di Oncologia, Milano, Italy. idemeest@ulb.ac.be. 2. Isabelle Demeestere, Julie Dechene, Yvon Englert, and Viviane De Maertelaer, Université Libre de Bruxelles; Alain Kentos and Yvon Englert, Erasme Hospital; Eric Van Den Neste, Cliniques Universitaires UCL Saint-Luc; Dominique Bron, J. Bordet Institute, Brussels; Pierre Zachee, Algemeen Ziekenhuis Stuivenberg, Antwerpen, Belgium; Pauline Brice, St Louis Hospital, APHP; Jehan Dupuis, Hôpital Henri Mondor, Paris; Olivier Casasnovas, CHU de Dijon, Dijon, France; and Fedro A. Peccatori, Istituto Europeo di Oncologia, Milano, Italy.
Abstract
PURPOSE: We have reported previously that after 1-year follow up, gonadotropin-releasing hormone agonist (GnRHa) did not prevent chemotherapy-induced premature ovarian failure (POF) in patients with lymphoma, but may provide protection of the ovarian reserve. Here, we report the final analysis of the cohort after 5 years of follow up. PATIENTS AND METHODS: A total of 129 patients with lymphoma were randomly assigned to receive either triptorelin plus norethisterone (GnRHa group) or norethisterone alone (control group) during chemotherapy. Ovarian function and fertility were reported after 2, 3, 4, and 5 to 7 years of follow up. The primary end point was POF, defined as at least one follicle-stimulating hormone value of > 40 IU/L after 2 years of follow up. RESULTS:Sixty-seven patients 26.21 ± 0.64 years of age had available data after a median follow-up time of 5.33 years in the GnRHa group and 5.58 years in the control group (P = .452). Multivariate logistic regression analysis showed a significantly increased risk of POF in patients according to age (P = .047), the conditioning regimen for hematopoietic stem cell transplant (P = .002), and the cumulative dose of cyclophosphamide > 5 g/m(2) (P = .019), but not to the coadministration of GnRHa during chemotherapy (odds ratio, 0.702; P = .651). The ovarian reserve, evaluated using anti-Müllerian hormone and follicle-stimulating hormone levels, was similar in both groups. Fifty-three percent and 43% achieved pregnancy in the GnRHa and control groups, respectively (P = .467). CONCLUSION: To the best of our knowledge, this is the first long-term analysis confirming that GnRHa is not efficient in preventing chemotherapy-induced POF in young patients with lymphoma and did not influence future pregnancy rate. These results reopen the debate about the drug's benefit in that it should not be recommended as standard for fertility preservation in patients with lymphoma.
RCT Entities:
PURPOSE: We have reported previously that after 1-year follow up, gonadotropin-releasing hormone agonist (GnRHa) did not prevent chemotherapy-induced premature ovarian failure (POF) in patients with lymphoma, but may provide protection of the ovarian reserve. Here, we report the final analysis of the cohort after 5 years of follow up. PATIENTS AND METHODS: A total of 129 patients with lymphoma were randomly assigned to receive either triptorelin plus norethisterone (GnRHa group) or norethisterone alone (control group) during chemotherapy. Ovarian function and fertility were reported after 2, 3, 4, and 5 to 7 years of follow up. The primary end point was POF, defined as at least one follicle-stimulating hormone value of > 40 IU/L after 2 years of follow up. RESULTS: Sixty-seven patients 26.21 ± 0.64 years of age had available data after a median follow-up time of 5.33 years in the GnRHa group and 5.58 years in the control group (P = .452). Multivariate logistic regression analysis showed a significantly increased risk of POF in patients according to age (P = .047), the conditioning regimen for hematopoietic stem cell transplant (P = .002), and the cumulative dose of cyclophosphamide > 5 g/m(2) (P = .019), but not to the coadministration of GnRHa during chemotherapy (odds ratio, 0.702; P = .651). The ovarian reserve, evaluated using anti-Müllerian hormone and follicle-stimulating hormone levels, was similar in both groups. Fifty-three percent and 43% achieved pregnancy in the GnRHa and control groups, respectively (P = .467). CONCLUSION: To the best of our knowledge, this is the first long-term analysis confirming that GnRHa is not efficient in preventing chemotherapy-induced POF in young patients with lymphoma and did not influence future pregnancy rate. These results reopen the debate about the drug's benefit in that it should not be recommended as standard for fertility preservation in patients with lymphoma.
Authors: A Balduzzi; J-H Dalle; K Jahnukainen; M von Wolff; G Lucchini; M Ifversen; K T Macklon; C Poirot; T Diesch; A Jarisch; D Bresters; I Yaniv; B Gibson; A M Willasch; R Fadini; L Ferrari; A Lawitschka; A Ahler; N Sänger; S Corbacioglu; M Ansari; R Moffat; A Dalissier; E Beohou; P Sedlacek; A Lankester; C D De Heredia Rubio; K Vettenranta; J Wachowiak; A Yesilipek; E Trigoso; T Klingebiel; C Peters; P Bader Journal: Bone Marrow Transplant Date: 2017-07-24 Impact factor: 5.483
Authors: Alexandra Higgins; Zaraq Khan; Charles C Coddington; Shahrukh K Hashmi; Mehrdad Hefazi; Hassan Alkhateeb; Mark R Litzow; William J Hogan; Elizabeth Cathcart-Rake; Carrie A Thompson; Mrinal M Patnaik Journal: Biol Blood Marrow Transplant Date: 2019-02-15 Impact factor: 5.742