BERKELEY, CA (UroToday.com) - Few studies have evaluated the impact of contemporary chemotherapy on fertility in young men treated for early stage lymphoma. In the July 1st issue of the Journal of Clinical Oncology, van der Kaaij and colleagues present fertility data retrospectively collected from 4 randomized European trials initially designed to evaluate the efficacy of alternative chemotherapeutic regimens for early stage Hodgkin’s lymphoma.

Out of an initial pool of 2,362 patients enrolled in 4 trials, 545 men were identified with at least one follicle-stimulating hormone (FSH) level after treatment and a normal FSH before treatment. The first subgroup consisted of 355 patients with one FSH level measured at least 12 months after completion of chemotherapy. This cohort served to evaluate the impact of chemotherapy on post-treatment fertility. Another subgroup of 349 men underwent FSH measurements 0 to 9 months after chemotherapy and was followed until recovery to assess the velocity of recovery. The median age of the all patients was 32 years.

The relationship between the type of chemotherapy (alkylating versus non-alkylating) and fertility was assessed. Fertility was defined as an elevation in serum FSH greater than 10 U/L. Alkylating regimens included MOPP (mechlorethamine, vincristine, procarbazine, prednisone), MOPP/ABV (doxorubicin, bleomycin, vinblastine), or BEACOPP (bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, prednisone). Non-alkylating agents included ABVD (doxorubicin, bleomycin, vinblastine, dacarbazine), and EBVP (epirubicin, bleomycin, vinblastine, prednisone).

The impact on fertility on patients treated with radiotherapy alone or with non-alkylating agents was low with only 3 and 8% exhibiting elevated FSH levels after treatment. Conversely, 60% of patients treated with alkylating agents developed elevated FSH levels after treatment. After a median of 19 months, approximately one-third of patients treated with alkylating agents had recovered fertility when compared to 82% of patients treated with non-alkylating agents (p < 0.001). Patients with stage II disease, a higher dose of alkylating agents, and men older than 50 years exhibited a higher risk of losing fertility.

These data compiled from 4 European trials suggest that alkylating chemotherapeutic agents may heavily impact male fertility in men treated for Hodgkin’s lymphoma. The main limitation of the study was that fertility estimates were based on serum FSH levels and not quantitative semen analyses or conception. Furthermore, serum FSH levels were not available for all patients. Nevertheless, these data underscore the need to develop alternative chemotherapeutic regimens to maximize treatment and fertility in young men with lymphoma. Van der Kaaij MAE, Heutte N, Le Stang N, Raemaekers JMM, Simons AHM, Carde P, Noordijk EM, Fermé C, Thomas J, Eghbali H, Kluin-Nelemans HC, Henry-Amar M

J Clin Oncol. 25(19): 2825-2832, July 2007.

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Written by Ricardo Sånchez-Ortiz, MD, a Contributing Editor with UroToday.

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