Reproduction patterns among classical Hodgkin lymphoma survivors treated with BEACOPP and ABVD in Sweden, Denmark and Norway—A population-based matched cohort study

Joshua P. Entrop*, Caroline E. Weibull, Karin E. Smedby, Lasse H. Jakobsen, Andreas K. Øvlisen, Daniel Molin, Ingrid Glimelius, Anna Marklund, Harald Holte, Alexander Fosså, Knut B. Smeland, Tarec C. El-Galaly, Sandra Eloranta

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Abstract

Childbirth rates in classical Hodgkin lymphoma (cHL) survivors have historically been reduced compared to the general population. Understanding if contemporary treatment protocols are associated with reduced fertility is crucial as treatment guidelines shift toward more liberal use of intensive chemotherapy. We identified 2834 individuals aged 18-40 years with cHL in Swedish and Danish lymphoma registers, and in the clinical database at Oslo University Hospital diagnosed 1995-2018, who were linked to national medical birth registers. Cox regression adjusted for stage, performance status, year, and age at diagnosis was used to estimate hazard ratios (HRs) and 95% confidence intervals (CI) contrasting time to first childbirth by treatment groups (ABVD, 2-4 BEACOPP, 6-8 BEACOPP) up to 10 years after diagnosis. Overall, 74.8% of patients were treated with ABVD, 3.1% with 2-4 BEACOPP and 11.2% with 6-8 BEACOPP. Adjusted HRs comparing childbirth rates in individuals treated with 6-8 BEACOPP, and 2-4 BEACOPP to ABVD were 0.53 (CI: 0.36-0.77) and 0.33 (CI: 0.12-0.91) for males, and 0.91 (CI: 0.61-1.34) and 0.38 (CI: 0.12-1.21) for females. Cumulative incidence of childbirths after 10 years was 19.8% (CI: 14.5%-27.0%) for males and 34.3% (CI: 25.8%-45.6%) for females treated with 6-8 BEACOPP. Proportions of children born after assisted reproductive technique (ART) treatments were 77.4% (CI: 60.2-88.6%) for males following 6-8 BEACOPP, and <11% for females. Among ABVD treated patients the corresponding proportions were 12.2% (CI: 8.5%-17.3%) and 10.6% (CI: 7.4%-14.9%). BEACOPP treatment is associated with decreased childbirth rates compared to ABVD in male, but not female, cHL patients, despite widespread access to ART in the Nordics.

OriginalsprogEngelsk
TidsskriftInternational Journal of Cancer
Vol/bind153
Udgave nummer4
Sider (fra-til)723-731
ISSN0020-7136
DOI
StatusUdgivet - 15. aug. 2023

Bibliografisk note

Funding Information:
This study has been supported by research grants from the Swedish, and Danish Cancer Society, the Nordic Cancer Union, Åke Wiberg Stiftelse and Karolinska Institutets Foundations. The authors would like to thank RKKP and all physicians who contributed to reporting data to LYFO.

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