Parenthood for Childhood Hodgkin Lymphoma Survivors

Women who were diagnosed with and treated for Hodgkin lymphoma during childhood and adolescence had similar rates of post-treatment parenthood as that of the general female population, according to the results of a German study published in Lancet Oncology.

“Women who have had treatment for Hodgkin lymphoma before age 18 years can be reassured that pregnancy is possible, and that they are likely to give birth to a healthy child,” wrote Jürgen H. Brämswig, MD, of University Children’s Hospital in Münster, Germany, and colleagues.

The study looked at 467 female survivors of Hodgkin lymphoma diagnosed at age 18 years or younger. All patients included in the study had to have 5 years of follow-up, be in continuous complete remission, and have no second malignancy or Hodgkin lymphoma relapse before parenthood occurred. These survivors were compared with the German female population aged 16 to 49 years.

The median follow-up of patients was 20.4 years. Of the patients, 228 (49%) had 406 children. The cumulative incidence of parenthood was 67%.

“In our sample of Hodgkin lymphoma survivors, a median of 1.78 children were born per mother, which is slightly higher than the 1.33 live births reported in the Childhood Cancer Survivor Study (CCSS),” the researchers wrote.

The researchers found no difference in the incidence of parenthood among the survivors and the general population at any point except for 66 women aged 40 to 44 years at the time of last follow-up. These women had significantly lower incidences of parenthood compared with the general population (61% vs 78%; P = .001) for reasons that the researchers said were not well understood.

“Forty-three (65%) of the 66 patients aged 40–44 years were long-term survivors of the two earliest trials, HD-78 and HD-82. They received higher doses of chemotherapy than did patients in the other three studies, especially those in the HD-78 study, which administered four to six cycles of COPP chemotherapy [cyclophosphamide, vincristine, procarbazine, and prednisone] in therapy groups 2 and 3, high doses of radiotherapy to the involved field (36–40 Gy), and a random assignment of 36–40 Gy or 18–20 Gy to adjacent fields in therapy groups 1–3,” the researchers wrote. “Because of these factors, women treated with the early protocols HD-78 and HD-82 might have been hesitant to become pregnant because the long-term side effects, including fertility, parenthood, and the health of children, were unknown.”

When looking at the effects of various treatments on likelihood of parenthood, the researchers found that parenthood was significantly reduced among those women who had been treated with pelvic radiation compared with those treated with abdominal or supradiaphragmatic radiation (hazard ratio [HR] = 0.76, 95% confidence interval [CI], 0.61–0.95; P = .01). No effect or only minor effects on parenthood were found for procarbazine in cumulative doses up to 11,400 mg/m², cyclophosphamide in cumulative doses up to 6,000 mg/m², alkylating agent dose scores of 1 to 5, therapy group based on disease stage at diagnosis, abdominal and supradiaphragmatic radiation, and age at treatment.