Childhood Lymphoma Survivors May Have a Greater Fertility Decline

Women treated for Hodgkin lymphoma during childhood tended to have poorer fertility markers than others without a history of cancer, recent research showed.

Pregnancy after cancer treatment can come with complications for a patient with Hodgkin lymphoma, according to a recent study.

“As a negative side effect, cancer treatment can reduce the number of egg cells or affect the normal function of the ovary”, explained Dr. Katja Drechsel,a PhD candidate at the Princess Máxima Centre for Paediatric Oncology.

Researchers studied how women who were treated for Hodgkin lymphoma can have a higher chance of abnormal fertility markers in the blood and a lower number of egg cells, compared to women who received no treatment.

The study was based on two groups: one group consisted of 84 women around the age of 30 who underwent treatment during their childhood at an average age of 13 years old. The second group consisted of almost 800 women who had not been treated for Hodgkin lymphoma.

Each woman was asked how old they were during their first pregnancy and also underwent testing for three different fertility markers (anti-Mullerian hormone, follicle stimulating hormone and inhibin B) within the blood.

“The markers that we studied reflect the number of remaining egg cells or function of the ovary. These markers become abnormal if a woman has a lower egg reserve or impaired ovarian function,” explained Drechsel.

Another component examined was an ultrasound to detect the quantity of egg cells within the ovaries.

Although pregnancy rates and live birth rates were similar between both groups, women who received childhood treatment for Hodgkin lymphoma were more likely to have abnormal fertility markers and fewer egg cells in their ovaries compared to the group who received no treatment.

“As a negative side effect, cancer treatment can reduce the number of egg cells or affect the normal function of the ovary. However, the treatment is necessary for patients to cure Hodgkin lymphoma,” explained Drechsel.

Women who received treatment had also spent a few years trying before becoming pregnant. This group also had their first pregnancies a few years earlier than most of the women in the other control group, which could be because their doctors recommended a pregnancy at a younger age for those who endured Hodgkin lymphoma childhood treatment, according to Drechsel.

“And we would like to emphasize that newly diagnosed patients should personally be informed about the (fertility) risks of their treatment. As mentioned before, current treatment for Hodgkin lymphoma is different compared to standard treatment in previous years, but there are still risks and everybody deserves to be informed about these risks,” explained Drechsel.

Since this study is based on childhood treatments, most of which were during the 1970s, 80s and 90s, new treatments and modernized technology may be less toxic today, possibly changing results within the study, according to Drechsel.

“Patients will now often receive less toxic chemotherapy and lower radiotherapy doses, but the treatment still contains toxic medicines. We hope that children who are currently (being) treated for Hodgkin lymphoma have a lower risk to have problems with fertility later in life. But we need to study this in more detail, before we know for sure,” explained Drechsel.

Another fertility study is underway to ensure that more information is investigated for patients with Hodgkin lymphoma. Drechsel discusses that, “In this study, led by Dr. Margreet Veening at the Amsterdam UMC location VUmc, Amsterdam and Princess Máxima Center for pediatric oncology in Utrecht, the Netherlands, we look at markers of fertility in girls and boys who are treated according to the current standard European treatment schedule. We can share the first results of this study in a few months, so we will then be able to answer this question in more detail.”

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