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Risk of Premature Menopause After Treatment for Hodgkin's Lymphoma

Lookup NU author(s): Dr Helen Lucraft

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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.


Publication metadata

Author(s): 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 Wales Hodgkin Lymphoma

Publication type: Article

Publication status: Published

Journal: Journal of the National Cancer Institute

Year: 2014

Volume: 106

Issue: 9

Print publication date: 01/09/2014

Online publication date: 19/08/2014

Acceptance date: 03/06/2014

ISSN (print): 0027-8874

ISSN (electronic): 1460-2105

Publisher: Oxford University Press

URL: http://dx.doi.org/10.1093/jnci/dju207

DOI: 10.1093/jnci/dju207


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