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

• 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
• DOI: 10.1002/pbc.27232
• EISSN: 1545-5017
• ISSN: 1545-5009

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.