Risk of premature menopause after treatment for Hodgkin’s lymphoma.
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Authors
Brammer, Caroline
Issue Date
2014-08-19
Journal
Type
Article
Peer-Reviewed Publication
Peer-Reviewed Publication
Keywords
Adult
Adolescent
Alkylating antineoplastic agents
Antineoplastic combined chemotherapy protocols
Bleomycin
Carmustine
Chemotherapy regimen
Child
Cytarabine
Dacarabazine
Doxorubicin
England
Etoposide
Follow-up studies
Hematopoietic stem cell transplantation
Hodgin disease
Infant
Melphalan
Menopause
Menopause
Ovarian irradiaton
Ovary
Peer-reviewed article
Poisson distribution
Pregnancy
Premature menopause
Preschool child
Proportional hazard models
Questionnaire
Radiation therapy
Radiotherapy dosage
Retrospective study
Risk assessment
Survey
Vinblastine
Wales
Young adult
Adolescent
Alkylating antineoplastic agents
Antineoplastic combined chemotherapy protocols
Bleomycin
Carmustine
Chemotherapy regimen
Child
Cytarabine
Dacarabazine
Doxorubicin
England
Etoposide
Follow-up studies
Hematopoietic stem cell transplantation
Hodgin disease
Infant
Melphalan
Menopause
Menopause
Ovarian irradiaton
Ovary
Peer-reviewed article
Poisson distribution
Pregnancy
Premature menopause
Preschool child
Proportional hazard models
Questionnaire
Radiation therapy
Radiotherapy dosage
Retrospective study
Risk assessment
Survey
Vinblastine
Wales
Young adult
Journal Title
Journal of the National Cancer Institute
Volume
106
Issue
9
Begin page
1
End page
12
Abstract
Background
Modern treatment of Hodgkin’s lymphoma (HL) has transformed its prognosis but causes late effects, including premature menopause. Cohort studies of premature menopause risks after treatment have been relatively small, and knowledge about these risks is limited.
Methods
Nonsurgical menopause risk was analyzed in 2127 women treated for HL in England and Wales at ages younger than 36 years from 1960 through 2004 and followed to 2003 through 2012. Risks were estimated using Cox regression, modified Poisson regression, and competing risks. All statistical tests were two-sided.
Results
During follow-up, 605 patients underwent nonsurgical menopause before age 40 years. Risk of premature menopause increased more than 20-fold after ovarian radiotherapy, alkylating chemotherapy other than dacarbazine, or BEAM (bis-chloroethylnitrosourea [BCNU], etoposide, cytarabine, melphalan) chemotherapy for stem cell transplantation, but was not statistically significantly raised after adriamycin, bleomycin, vinblastine, dacarbazine (ABVD). Menopause generally occurred sooner after ovarian radiotherapy (62.5% within five years of ≥5 Gy treatment) and BEAM (50.9% within five years) than after alkylating chemotherapy (24.2% within five years of ≥6 cycles), and after treatment at older than at younger ages. Cumulative risk of menopause by age 40 years was 81.3% after greater than or equal to 5Gy ovarian radiotherapy, 75.3% after BEAM, 49.1% after greater than or equal to 6 cycles alkylating chemotherapy, 1.4% after ABVD, and 3.0% after solely supradiaphragmatic radiotherapy. Tables of individualized risk information for patients by future period, treatment type, dose and age are provided.
Conclusions
Patients treated with HL need to plan intended pregnancies using personalized information on their risk of menopause by different future time points.
Citation
Swerdlow AJ, Cooke R, Bates A, Cunningham D, Falk SJ, Gilson D, Hancock BW, Harris SJ, Horwich A, Hoskin PJ, Linch DC, Lister A, Lucraft HH, Radford J, Stevens AM, Syndikus I, Williams MV; England and Wales Hodgkin Lymphoma Follow-up Group. Risk of premature menopause after treatment for Hodgkin's lymphoma. J Natl Cancer Inst. 2014 Aug 19;106(9):dju207. doi: 10.1093/jnci/dju207. PMID: 25139687.