Public Release: 

New ECCO 13 studies probe impact of haematological cancer therapy on future fertility

ECCO-the European CanCer Organisation

Paris, France, Thursday 3 November 2005 - Despite the proven positives of chemotherapy and radiotherapy in improving clinical outcomes for cancer sufferers, these survival benefits can come at a cost. In an effort to further assess the long-term impact of cancer treatment, two studies showcased at the 13th European Cancer Conference (ECCO) have examined the effect of chemotherapy and radiotherapy for haematological malignancies on subsequent patient fertility.

The first such study looked at 276 males and 221 females treated for Hodgkin's lymphoma at the Norwegian Radium Hospital between 1971 and 1999. An average of 16 years after their cancer therapy these patients were questioned about their attempts and successes in achieving parenthood. The results were then correlated with the type of treatment the patients received - either radiotherapy alone, chemotherapy only or a combination of both. The type of chemotherapy was also divided into three groups (low, medium or high) according to the regimens' expected gonadotoxicity (toxicity to testes or ovaries).

Overall the study revealed 71% of men and 76% of women who attempted post-treatment parenthood following treatment for Hodgkins lymphoma, were successful - 10% of men and 1% of women used assisted reproduction techniques. It is estimated that about 90% of the general population attempting pregnancy achieve this within the first year. In total, 70 women had completed pregnancies, of whom only one required reproductive intervention. As with the men, significantly more successful attempts at parenthood stemmed from those patients treated with radiotherapy alone. Unsurprisingly, for both men and women, the highest parenthood success rates among the chemotherapy treated patients were seen in those who received the therapy with the lowest gonadotoxicity.

"Our results indicate that fertility is a major concern for long term survivors after cancer treatment in young adult life," noted study author Dr Cecille Kiserud from Rikshospitalet - Radiumhospitalet Trust, Norway. "In the future it will be important to work towards minimising treatment as much as possible in attempt to preserve fertility and reduce other long term side effects after cancer treatment. It is also of importance to further develop techniques to preserve and restore fertility in both male and female cancer patients."

About Hodgkin's Lymphoma

Hodgkin's disease is a malignant growth of cells in the lymph system. There are two main types of lymphoma, Hodgkins and non-Hodgkins lymphoma. What differentiates the two is the appearance of the white blood cells under the microscope - the Reed Sternberg cells only found in Hodgkin's lymphomas. These cells are believed to be the B lymphocytes (a type of white blood cell) which become cancerous. 1

It is the commonest cancer in Western Europe in adolescents; Males - 3.7/100,000/year, Females - 2.5/100,000/year. Peak incidence is around 15 to 25 years and then rises again after the age of 55. 2

There are some causal factors associated with the disease; infection with the Epstein Barr virus (which causes glandular fever), cigarette smoking, HIV and immunosuppression and even links with the measles virus.2,3 Characteristic symptoms include swelling of the lymph nodes, fever, weight loss, night sweats and itching.

It is one of the most treatable cancers even offering cures in some cases. The disease is first staged to assess how widespread it is. If the cancer is at the early stage, then patients are offered radiotherapy on the affected lymph nodes. Although chemotherapy would also be given to stop any spreading of the disease. When the disease is more widespread, chemotherapy is always given. If the disease recurs then bone marrow and peripheral blood transplants are recommended. Immunotherapy including monoclonal antibody therapy are currently under investigation as future therapy options. 3

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1 www.cancerhelp.org.uk
2 www.patient.co.uk
3 www.lymphomainfo.net

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Abstract: 975
2022 Haematological malignancies in children and adults - long term side effects
Post-treatment parenthood in survivors after Hodgkin's lymphoma
C.E. Kiserud1, A. Fossa2, H. Holte2, T. Bjøro3, S.D. Fossa1
1Unit for long term outcome, Department of clinical cancer research, Rikshospitalet-Radiumhospitalet TRUST, Oslo, Norway
2Department of medical oncology and radiotherapy, Rikshospitalet-Radiumhospitalet TRUST, Oslo, Norway
3Central laboratory, Rikshospitalet-Radiumhospitalet TRUST, Oslo, Norway
Background:
Post-treatment parenthood (PtP) is an important dimension of the treatment and quality of life in young patients with Hodgkin's lymphoma (HL).
Methods:
In 2002 276 males and 221 females treated for HL at the Norwegian Radium Hospital from 1971-99 completed a questionnaire in men assessing their attempts and success to achieve PtP and in females recording the number of completed pregnancies. 3 principal therapeutic groups were constructed: 1: Radiotherapy (RT) only (Rad), 2: Chemotherapy only (Chem), 3: RT and chemotherapy in combination (RaCh). Chemotherapy was divided in 3 groups (low, medium, high) according to the regimens' expected gonadotoxicity (GT). RT was subgrouped depending on whether infradiaphragmatic RT was given or not. Data were analysed by Kaplan-Meier and log rank tests using birth of 1. child post-treatment as primary endpoint.
Results:
Of 121 males who attempted PtP, 84 were successful and had 1-5 children after their treatment. 70 females achieved PtP (1-4 children). 18 of the males had used assisted reproduction techniques (ARTs), 9 of them becoming a father. 3 of the females had used ARTs, one of them achieving pregnancy.
With a mean observation time of 16 years successful attempts of PtP were recorded in 85% (29/34) of the males in the Rad group, in 67% (10/15) in the Chem group and in 63% (45/72) in the RaCh group, with significant difference between the success rate in the Rad group compared to the two other groups (p=0,04 vs Chem, p=0,02 vs RaCh). In the females there was a similar significant difference between the Rad group and the two other groups (p=0,01 vs Chem, p=0,02vs RaCh).
For both the males and the females there were no differences in PtP between the two subgroups of RT. In males there was a significant difference in PtP between all three groups of chemotherapy, with highest success rate in the low GT group, and the lowest success rate in the group with high GT. In females there was a significant difference in achieving PtP between the low and the high GT group.
Conclusions:
In this study 69 % of males who attempted PtP were successful with only 11% of them using ARTs. The success rate for female patients seems lower, though the exact rate of success is not yet available. In both males and females the chance of PtP was significantly highest in the Rad group and the low GT group.

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