Impact of ovarian transposition before pelvic irradiation on ovarian function among long‐term survivors of childhood Hodgkin lymphoma: A report from the St. Jude Lifetime Cohort Study

Background We reviewed the effect of ovarian transposition (OT) on ovarian function among long‐term survivors of childhood Hodgkin lymphoma (HL) treated with pelvic radiotherapy. Procedure Female participants (age 18+ years) with HL in the St. Jude Lifetime Cohort Study (SJLIFE) were clinically eval...

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Published in:	Pediatric blood & cancer Vol. 65; no. 9; pp. e27232 - n/a
Main Authors:	Fernandez‐Pineda, Israel, Davidoff, Andrew M., Lu, Lu, Rao, Bhaskar N., Wilson, Carmen L., Srivastava, D. Kumar, Klosky, James L., Metzger, Monica L., Krasin, Matthew J., Ness, Kirsten K., Pui, Ching‐Hon, Robison, Leslie L., Hudson, Melissa M., Sklar, Charles A., Green, Daniel M., Chemaitilly, Wassim
Format:	Journal Article
Language:	English
Published:	United States Wiley Subscription Services, Inc 01-09-2018
Subjects:	Age Alkylating agents Alkylation Children Cohort analysis Cryopreservation Cyclophosphamide Females Fertility Health risk assessment Hematology Hodgkin lymphoma Hodgkin's lymphoma Irradiation late effects Lymphoma Menopause Oncology ovarian transposition Pediatrics Pregnancy premature ovarian insufficiency Radiation therapy Reproductive status Transposition ovarian transposition premature ovarian insufficiency late effects Hodgkin lymphoma
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Summary:	Background We reviewed the effect of ovarian transposition (OT) on ovarian function among long‐term survivors of childhood Hodgkin lymphoma (HL) treated with pelvic radiotherapy. Procedure Female participants (age 18+ years) with HL in the St. Jude Lifetime Cohort Study (SJLIFE) were clinically evaluated for premature ovarian insufficiency (POI) 10 or more years after pelvic radiotherapy. Reproductive history including age at menopause and pregnancy/live births was available on all patients. Results Of 127 eligible females with HL, 90 (80%) participated in SJLIFE, including 49 who underwent OT before pelvic radiotherapy. Median age at STLIFE evaluation was 38 years (range 25–60). In a multiple regression adjusted for age at diagnosis, pelvic radiotherapy doses > 1,500 cGy (hazard ratio [HR] = 25.2, 95% confidence interval [CI] = 3.1–207.3; P = 0.0027) and cumulative cyclophosphamide equivalent doses of alkylating agents > 12,000 mg/m2 (HR = 11.2, 95% CI = 3.4–36.8; P < 0.0001) were significantly associated with POI. There was no significant association between OT and occurrence of POI (HR = 0.6, 95% CI = 0.2–1.9; P = 0.41). Conclusions OT did not appear to modify risk of POI in this historic cohort of long‐term survivors of HL treated with gonadotoxic therapy. Modern fertility preservation modalities, such as mature oocyte cryopreservation, should be offered to at‐risk patients whenever feasible.
Bibliography:	This study was presented as an oral presentation at the annual meeting of the International Society of Paediatric Oncology (SIOP), Washington DC, in October 2017. Grant sponsor: National Cancer Institute (NIH), Grant number: CA 21765, Grant sponsor: ALSAC ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	1545-5009 1545-5017
DOI:	10.1002/pbc.27232