Fertility and gonadal function in female survivors after treatment of early unfavorable Hodgkin lymphoma (HL) within the German Hodgkin Study Group HD14 trial

Background In the HD14 trial, 2× BEACOPPescalated+2× ABVD (2+2) has improved the primary outcome. Compared with 4× ABVD, this benefit might be compromised by more infertility in women. Therefore, we analyzed gonadal function and fertility. Patients and methods Women ≤45 years in ongoing remission at least 1 year after therapy were included. Hormone parameters, menopausal symptoms, measures to preserve fertility, menstrual cycle, pregnancies, and offspring were evaluated. Results Three hundred and thirty one of 579 women addressed participated (57.2%) and 263 per-protocol treated patients qualified (A=ABVD: 137, B=2+2: 126, mean time after therapy 42 and 43 months, respectively). Regular menstrual cycle after treatment (A: 87%, B: 83%) and time to recovery (≤12 months) were not different. Follicle-stimulating hormone and anti-Muellerian hormone were significantly better in arm A. However, pregnancies after therapy favored arm B (A: 15%, B: 26%, P=0.043) and motherhood rates were equivalent to the German normal population. Multivariate analysis revealed prophylactic use of gonadotropin-releasing hormone (GnRH) analogues as highly significant prognostic factor for preservation of fertility (odds ratio=12.87, P=0.001). Severe menopausal symptoms were frequent in women ≥30 years (A: 21%, B: 25%). Conclusions Hormonal levels after 2+2 indicate a reduced ovarian reserve. However, 2+2 in combination with GnRH analogues does not compromise fertility within the evaluated observation tim

Bolus dynamic computed tomography in the evaluation of pulmonary sequestration

Three cases of pulmonary sequestration evaluated by bolus dynamic computed tomography are described. The computed tomography appearance and the differential diagnosis are discussed. It is important to recognize the advantages of the bolus dynamic technique in the evaluation of pulmonary sequestration as it may eliminate the need for further studies.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/26560/1/0000099.pd

Fertility and gonadal function in female survivors after treatment of early unfavorable Hodgkin lymphoma (HL) within the German Hodgkin Study Group HD14 trial

In the HD14 trial, 2×BEACOPPescalated+2×ABVD (2+2) has improved the primary outcome. Compared with 4×ABVD, this benefit might be compromised by more infertility in women. Therefore, we analyzed gonadal function and fertility

Late sequelae and survivorship following treatment of Hodgkin's lymphoma

As a consequence of the impressive long-term remission rates in Hodgkin's lymphoma (HL) patients, current clinical research focuses on the reduction of treatment-related delayed complications. Thus, carefully conducted analyses of treatment-related sequelae which can occur during the survivorship period are needed. The most important treatment-related complication is the development of secondary neoplasms, which represent a significant risk of mortality in long-term HL survivors. Organ toxicities comprise cardiac, pulmonary and gonadal dysfunction, of which the latter is particularly important in young survivors with a desire to have children. At diagnosis, physicians should thoroughly inform the patient and consider protective methods to preserve fertility. Furthermore, the quality of life in HL survivors is lower than in controls of the same age. Most survivors suffer from cancer-related fatigue, which can persist a long time after primary treatment. The therapeutic strategies of most recent clinical trials in HL aim at reducing therapy-related late sequelae with a simultaneous retention of good tumor control

The Unique Characteristics and Management of Patients Over 60 Years of Age with Classic Hodgkin Lymphoma

In recent decades, the prognosis of Hodgkin lymphoma has been substantially improved, but these successes have been restricted to younger patients and could not be translated into a major benefit for older patients, especially those with advanced-stage disease. Major problems in treating older patients include a different biology, frailty, comorbidities, and poorer tolerance of therapy. Additionally, these patients are often excluded from randomized trials, so an evidence-based standard of care is lacking. Importantly, the proportion of older patients with HL will increase over the next 50 years. Currently, ABVD (Adriamycin [doxorubicin], bleomycin, vinblastine, and dacarbazine) is considered to be the gold standard, even though it has some toxicity in older patients and prospective data are not available. Thus, further studies are required, including the assessment of comorbidities and the incorporation of new drugs such as immunomodulatory agents, antibody-drug conjugates, mTOR inhibitors, or histone deacetylase (HDAC) inhibitors