Fertility in Hodgkin lymphoma survivors

Hodgkin lymfoom is een doorgaans goed te genezen lymfeklierkanker, waarbij 70% van de patiënten onder de 40 jaar is. Eén van de problemen waar overlevenden regelmatig mee worden geconfronteerd, is onvruchtbaarheid. Bij mannen treedt onvruchtbaarheid vaker op en laat herstel langer op zich wachten als er alkylerende chemotherapie gegeven is. 32 maanden na behandeling heeft 60% van de mannen behandeld met alkylerende chemotherapie hoge FSH-spiegels, tegenover 3-8% zonder alkylerende chemotherapie. Bij vrouwen behandeld voor Hodgkin lymfoom kwam 20% vroegtijdig in de overgang, tegen 0,9% in de algemene bevolking. Per cyclus alkylerende chemotherapie stijgt het risico op menopauze voor het 40e met 50%. Per jaar dat een patiënte ouder is bij start van behandeling, stijgt het risico op menopauze voor het 40e met 23%. Het blijkt dat zij die Hodgkin hebben gehad iets minder vaak kinderen krijgen dan de algemene bevolking. Echter, het verschil is maar klein en betreft alleen de vrouwen en alleen overlevenden die al kinderen hadden voor behandeling. Bij mannen met Hodgkin lymfoom is de zaadkwaliteit voor start van behandeling bijna altijd goed genoeg om sperma in te vriezen. Bij 7% is de zaadkwaliteit slecht, waaronder 3% waarbij het ejaculaat geen zaadcellen bevat. Deze laatste groep kan dus niet geholpen worden door sperma in te vriezen. Mannen die sperma hadden ingevroren hadden een dubbel zo grote kans vader te worden na behandeling. Na behandeling van Hodgkin is 1 op de 5 kinderen van mannelijke overlevenden geboren dankzij ingevroren sperma

Parenthood in survivors of Hodgkin lymphoma: an EORTC-GELA general population case-control study.

Contains fulltext : 108966.pdf (publisher's version ) (Open Access)PURPOSE: We investigated the impact of Hodgkin lymphoma (HL) on parenthood, including factors influencing parenthood probability, by comparing long-term HL survivors with matched general population controls. PATIENTS AND METHODS: A Life Situation Questionnaire was sent to 3,604 survivors treated from 1964 to 2004 in successive clinical trials. Responders were matched with controls (1:3 or 4) for sex, country, education, and year of birth (10-year groups). Controls were given an artificial date of start of treatment equal to that of their matched case. The main end point was presence of biologic children after treatment, which was evaluated by using conditional logistic regression analysis. Logistic regression analysis was used to analyze factors influencing spontaneous post-treatment parenthood. RESULTS: In all, 1,654 French and Dutch survivors were matched with 6,414 controls. Median follow-up was 14 years (range, 5 to 44 years). After treatment, the odds ratio (OR) for having children was 0.77 (95% CI, 0.68 to 0.87; P < .001) for survivors compared with controls. Of 898 survivors who were childless before treatment, 46.7% achieved post-treatment parenthood compared with 49.3% of 3,196 childless controls (OR, 0.87; P = .08). Among 756 survivors with children before treatment, 12.4% became parents after HL treatment compared with 22.2% of 3,218 controls with children before treatment (OR, 0.49; P < .001). Treatment with alkylating agents, second-line therapy, and age older than 35 years at treatment appeared to reduce the chances of spontaneous post-treatment parenthood. CONCLUSION: Survivors of HL had slightly but significantly fewer children after treatment than matched general population controls. The difference concerned only survivors who had children before treatment and appears to have more personal than biologic reasons. The chance of successful post-treatment parenthood was 76%

Gestione del patrimonio immobiliare, Due Diligence ed Analisi Energetica.

Il tema della gestione tecnica ed amministrativa degli immobili sta attraversando un grande processo di rinnovamento poiché, tenendo in considerazione il LCCA, è sempre più chiara l'importanza che riveste all'interno dell'esercizio economico di qualsiasi Azienda. Da qui il bisogno di sviluppare strategie per gestire edifici e correggere le conseguenze di uno sviluppo immobiliare e di una gestione poco controllata. Si sente la necessità di definire la figura del Building Manager che attraverso l'utilizzo di opportuni Sistemi Informativi, possa coordinare le procedure al fine di prevedere, gestire ed ottimizzare le diverse problematicità della gestione immobiliare. Tali attività richiedono la disponibilità di dati significativi che, raccolti attraverso un adeguato processo di Due Diligence Immobiliare, portano alla profonda conoscenza del patrimonio. In questa Tesi si analizzano quindi le principali tematiche della gestione immobiliare al fine di creare un Sistema Informativo, che distribuito online gratuitamente o a pagamento, può essere utilizzato dal Building Manager. Si sono ipotizzati infine interventi di razionalizzazione degli spazi per un edificio adibito ad uffici e degli interventi di retrofit energetici, tenendo adeguatamente in considerazione i parametri economici sugli investimenti. The theme of the technical and administrative management of real estate is going through a great renewal process, taking into account the LCCA, is increasingly clear the importance within the economic's period of any Company. We need to define the figure of the Building Manager. Through the use of appropriate information systems, he can coordinate procedures to order, predict, manage and optimize the various problematic of management real estate. These activities require the availability of meaningful data, collected through adequate Due Diligence. In this thesis is then analyzed the main issues property management in order to create an information system, which distribute online for free or for a fee, can be used by the Building Manager. We hypothesized finally rationalization of space for a building used for offices and retrofit energy for a building used for boarding school, taking due in account the economic parameters on investment

Sperm quality before treatment in patients with early stage Hodgkin’s lymphoma enrolled in EORTC-GELA Lymphoma Group trials

Although widely recommended, cryopreservation of sperm is sometimes not performed for patients with Hodgkin’s lymphoma because of presumed poor sperm quality related to the disease. In this large study of males with Hodgkin’s lymphoma, 90% had good or intermediate sperm quality, indicating that in most patients with early-stage Hodgkin’s lymphoma sperm quality before treatment is good enough for future fatherhood

Fatigue level changes with time in long-term Hodgkin and non-Hodgkin lymphoma survivors: a joint EORTC-LYSA cross-sectional study

BackgroundLong-term lymphoma survivors often complain of persistent fatigue that remains unexplained. While largely reported in Hodgkin lymphoma (HL), long-term fatigue is poorly documented in non-Hodgkin lymphomas (NHL). Data collected in two cohort studies were used to illustrate the fatigue level changes with time in the two populations.MethodsTwo cross-sectional studies were conducted in 2009-2010 (HL) and in 2015 (NHL) in survivors enrolled in European Organisation for Research and Treatment of Cancer (EORTC) Lymphoma Group and Lymphoma Study Association (LYSA) trials. The same protocol and questionnaires were used in both studies including the Multidimensional Fatigue Inventory (MFI) tool to assess fatigue and a checklist of health disorders. Multivariate linear regression models were used in the two populations separately to assess the influence of time since diagnosis and primary treatment, age, gender, education level, cohabitation status, obesity and health disorders on fatigue level changes. Fatigue level changes were compared to general population data.ResultsOverall, data of 2023 HL and 1619 NHL survivors with fatigue assessment available (99 and 97% of cases, respectively) were analyzed. Crude levels of fatigue were similar in the two populations. Individuals who reported health disorders (61% of HL and 64% of NHL) displayed higher levels of fatigue than those who did not (

Geriatric assessment and treatment outcomes in a Dutch cohort of older patients with potentially curable esophageal cancer

Background Patients with potentially curable esophageal cancer can be treated with neo-adjuvant chemoradiotherapy followed by surgery or definitive chemoradiotherapy with curative intent. For frail older patients choosing the appropriate oncological treatment can be difficult, and data on geriatric deficits as determinants of treatment outcomes are not yet available. Objectives To describe the prevalence of geriatric deficits and to study their association with treatment discontinuation and mortality in older patients with potentially curable esophageal cancer. Material and Methods A cohort study was conducted in a Dutch tertiary care hospital including patients aged >= 70 years with primary stage I-IVA esophageal cancer. Geriatric screening and assessment data were collected. Outcomes were treatment discontinuation and one year all-cause mortality. Results In total, 138 patients with curable esophageal cancer were included. Mean age was 76.1 years (standard deviation 4.7), 54% had clinical stage III and 24% stage IVA disease. Most patients received neo-adjuvant chemoradiotherapy and surgery (41%), 32% definitive chemoradiotherapy and 22% palliative radiotherapy. Overall, one year all-cause mortality was 36%. Geriatric screening and assessment was performed in 94 out of 138 patients, of which 60% was malnourished, 20% dependent in Instrumental Activities of Daily Living (IADL) and 52% was frail. Malnutrition was associated with higher mortality risk (Hazard Ratio, 3.2; 95% Confidence Interval, 1.3-7.7)) independent of age, sex and tumor stage. Seventy-six out of 94 patients were treated with chemoradiotherapy, of which 23% discontinued treatment. Patients with IADL dependency and Charlson Comorbidity Index >= 1 discontinued treatment more often. Conclusion All-cause mortality within one year was high, irrespective of treatment modality. Treatment discontinuation rate was high, especially in patients treated with definitive chemoradiotherapy. Geriatric assessment associates with outcomes in older patients with esophageal cancer and may inform treatment decisions and optimization in future patients, but more research is needed to establish its predictive value