Parenthood in Long-Term Survivors After CHOEP Treatment for Aggressive Lymphoma Is Not Significantly Impaired in Comparison to the General Population. Results From the Mabthera International Trial (MInT) and the DSHNHL NHLB1 Study

Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 3649-3649
Author(s):  
Julia Meissner ◽  
Sascha Dietrich ◽  
Marita Ziepert ◽  
Evelyn Kuhnt ◽  
Tanja Rixecker ◽  
...  
Keyword(s):  
General Population ◽  
Hodgkin Lymphoma ◽  
Aggressive Lymphoma ◽  
Gnrh Analogue ◽  
International Trial ◽  
Female Patients ◽  
Male Patients ◽  
The Impact ◽  
Long Term Survivors

Abstract Abstract 3649 Background: A growing number of patients with aggressive lymphoma experience long term survival after front-line treatment and survivorship issues have been increasingly addressed in recent years. Within treatment-induced sequelae, gonadal failure represents a major late-effect of chemotherapy. With respect to hematologic malignancies the majority of data on fertility effects pertains to Hodgkin Lymphoma treatment regimens whereas information on gonadal toxicity of non-Hodgkin Lymphoma treatments is limited. While CHOP as the standard treatment for aggressive lymphoma is supposed to be associated with only temporary side-effects on fertility in both sexes, nothing is known about the fertility effect of a moderate intensification of CHOP by adding etoposide in frequently used regimens such as CHOEP or dose-adjusted EPOCH. Methods: Our study assessed fertility aspects in young patients with aggressive lymphoma who enjoy ongoing first remission after treatment in the Mabthera International Trial or the German DSHNHL NHLB1 study between 1995 and 2003. Long term survivors of both prospective studies were contacted and invited to answer a questionnaire. Patients who received radiotherapy to the gonadal area as part of their primary treatment as well as those who received chemotherapy for secondary neoplasia were excluded from the analysis. Data on parenthood obtained in the subgroup of patients who received 6 complete cycles (R)-CHOEP (total cyclophosphamide and etoposide dose 4,500 mg/m2 and 1,800 mg/m2, respectively) is reported here. Results: Altogether 66 (31 female, 35 male) patients agreed to participate in the survey. Median age at treatment was 32.5 years (range: 18 – 40) and at time of data collection 44 years (range: 28 – 55), respectively, with a median follow-up after treatment completion of 11 years (range: 7 – 17). While 31 (46.9%) patients already had children before treatment (18 female – 58.1%, 13 male – 37.1%), 35 (53.0%) expressed a clear desire for children after treatment (14 female – 45.2%, 21 male – 60.0%). Ten of these 35 patients did not try to achieve pregnancy, with lack of partner being the main reason. Of the remaining 25 patients (12 female, 13 male) who tried to achieve pregnancy, 18 (9 female – 75%, 9 male – 69%) were finally successful. Apart from 2 deliberate abortions all pregnancies were uncomplicated and resulted in 25 live births. No major health problems were reported in the children. The interval between completion of treatment and birth of first child after treatment ranged from 21 to 146 months (median 58 months) in female patients and from 25 months to 106 months (median 60.5 months) in male patients. Patients not achieving pregnancy tended to be older then patients who successfully achieved pregnancy (median age 30 versus 25 in female patients and 34.5 versus 28 years in male patients). Not achieving parenthood after treatment was associated with emotional stress in 3 of 3 female patients but only in 1 of 4 male patients. Fourteen patients chose cryopreservation of sperm before treatment but none of them utilized preserved sperm for reproductive purposes. Cryopreservation techniques were not used in female patients. Only one female patient received a GnRH analogue in parallel to chemotherapy and gave birth to two children after treatment. Comparison of the presented patient data with the German general population (The German Socio-Economic Panel, 2011) revealed only non-significant differences in the overall percentage of childless women (16.1% in the study population versus 26.0% in the general population, p=0.15) and men (45.7% versus 33.8%, p=0.07). Total fertility rate in female study patients (1.45) paralleled that in the general population (around 1.4 between 1980 and 2010). Conclusions: Parenthood after treatment with CHOP plus etoposide seems not to be significantly impaired in comparison to the general population. Most patients who had attempted post-treatment parenthood were successful. The small percentage of patients not achieving pregnancy despite a clear desire for parenthood after treatment is in line with previous reports on the fertility effects of CHOP. However, all patients of reproductive age should be offered counselling with regard to the impact of planned therapy on their fertility. Disclosures: No relevant conflicts of interest to declare.

scholarly journals Quality of Life Among Long-Term Survivors of Non-Hodgkin Lymphoma: A Follow-Up Study

2013 ◽  
Vol 31 (2) ◽  
pp. 272-279 ◽  
Author(s):  
Sophia K. Smith ◽  
Deborah K. Mayer ◽  
Sheryl Zimmerman ◽  
Christianna S. Williams ◽  
Habtamu Benecha ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Social Support ◽  
Hodgkin Lymphoma ◽  
Symptom Burden ◽  
Non Hodgkin Lymphoma ◽  
The Impact ◽  
Long Term Survivors ◽  
Over Time

Purpose Little is known about change in quality of life (QOL) among long-term cancer survivors. We examined change over time in QOL among long-term survivors of non-Hodgkin lymphoma and identified demographic, clinical, and psychosocial risk factors for poor outcomes. Methods Surveys were mailed to 682 lymphoma survivors who participated in a study 5 years earlier, when on average they were 10.4 years postdiagnosis. Standardized measures of QOL, perceptions of the impact of cancer, symptoms, medical history, and demographic variables were reported at both time points and examined using linear regression modeling to identify predictors of QOL over time. Results A total of 566 individuals participated (83% response rate) who were a mean of 15.3 years postdiagnosis; 52% were women, and 87% were white. One third of participants (32%) reported persistently high or improved QOL, yet a notable proportion (42%) reported persistently low or worsening QOL since the earlier survey. Participants who received only biologic systemic therapy reported improvement in physical health despite the passage of time. Older age, more comorbidity, and more or increasing negative and decreasing positive perceptions of cancer's impact were independent predictors of poor QOL. Lymphoma symptom burden, less social support, and having received a transplantation were related to negative perceptions of cancer's impact. Conclusion Moderate to severe symptom burden, limited social support, or having received a transplantation should alert the clinician to potential need for supportive services. Perceptions of cancer's impact are associated with QOL cross-sectionally and longitudinally; modifying these perceptions may thus provide a strategy for improving QOL.

scholarly journals Long-term cause-specific mortality in hodgkin lymphoma patients

2020 ◽  
Author(s):  
Simone de Vries ◽  
Michael Schaapveld ◽  
Cécile P M Janus ◽  
Laurien A Daniëls ◽  
Eefke J Petersen ◽  
...  
Keyword(s):  
General Population ◽  
Hodgkin Lymphoma ◽  
Primary Treatment ◽  
Subdistribution Hazard ◽  
Cumulative Mortality ◽  
Risk Of Death ◽  
Disease Mortality ◽  
Specific Mortality ◽  
The Impact

Abstract Background Few studies examined the impact of treatment-related morbidity on long-term cause-specific mortality in Hodgkin lymphoma (HL) patients. Methods This multicenter cohort included 4,919 HL patients, treated before age 51 between 1965–2000, with a median follow-up of 20.2 years. Standardized mortality ratios (SMRs), absolute excess mortality per 10,000 person-years (AEM) and cause-specific cumulative mortality by stage and primary treatment, accounting for competing risks were calculated. Results HL patients experienced 5.1-fold (AEM = 123 excess deaths per 10,000 person-years) higher risk of death due to causes other than HL. This risk remained increased in 40-year survivors (SMR = 5.2, 95% Confidence Interval (95%CI) = 4.2–6.5; AEM = 619). At age 54 years, HL survivors experienced similar cumulative mortality (20.0%) from causes other than HL as 71-year old individuals from the general population. While HL mortality statistically significantly decreased over calendar period (p < .001), solid tumor mortality did not change in the most recent treatment era. Patients treated in 1989–2000 had lower 25-year cardiovascular disease mortality than patients treated in 1965–1976 (4.3% vs. 5.7%; subdistribution Hazard Ratio (HR) = 0.65, 95%CI = 0.46–0.93). Infectious disease mortality was not only increased after splenectomy but also after spleen irradiation (HR = 2.81, 95%CI = 1.55–5.07). For stage I-II, primary treatment with chemotherapy alone was associated with statistically significantly higher HL mortality (p < .001 for CT vs. RT; p = .04 for CT vs. RT+CT), but lower 30-year mortality from causes other than HL (15.8%, 95%CI = 9.7%–23.3%), compared to radiotherapy alone (36.9%, 95%CI = 34.0%–39.8%; p = .001) and radiotherapy and chemotherapy combined (29.8%, 95%CI = 26.8%–32.9%; p = .02). Conclusion Compared to the general population, HL survivors have a substantially reduced life expectancy. Optimal selection of patients for primary CT is crucial, weighing risks of HL relapse and long-term toxicity.

The impact of cancer and quality of life for long-term survivors

2008 ◽  
Vol 17 (9) ◽  
pp. 891-900 ◽  
Author(s):  
Brad J. Zebrack ◽  
Jaehee Yi ◽  
Laura Petersen ◽  
Patricia A. Ganz
Keyword(s):  
Quality Of Life ◽  
The Impact ◽  
Long Term Survivors

scholarly journals An Exploration of the Reproductive Health Concerns in Women with Systemic Lupus Erythematosus

2021 ◽  
Vol 8 (2) ◽  
Author(s):  
Shimol JB ◽  
Keyword(s):  
Risk Factors ◽  
Systemic Lupus Erythematosus ◽  
General Population ◽  
Lupus Erythematosus ◽  
Antiphospholipid Antibodies ◽  
Unprotected Sex ◽  
Gnrh Analogue ◽  
Systemic Lupus ◽  
Child Bearing ◽  
The Impact

Systemic Lupus Erythematosus (SLE) is more frequent in women, with a female-to-male ratio ranging from 2-6:1 prior to puberty and 3-8:1 following menopause up to 8-15:1 during their fertile years [1]. SLE commonly begins when women are in their 20s, during the prime of their child-bearing years when they are often beginning to plan their families [2], and may have enormous impact on their childrearing. Although rates of infertility are not felt to be elevated among women with SLE, secondary amenorrhea has been identified in 13-17% of women with SLE who are naïve to cyclophosphamide, compared with a prevalence 1-5% in a healthy population [3]. One reason may be related lower levels of anti-Mullerian hormone [4] and higher levels of elevated anti-corpus luteum antibody levels in female patients with SLE [5]. According to one study, 64% women with SLE had fewer children than originally planned. This is likely a result of many factors including disease and medication impact on fertility and fear of disease flare-up with pregnancy. Moreover, many socioeconomic challenges accompany the disease, particularly concerns about the impact of SLE on child welfare and family life, a feature shared by many other chronic illnesses. One study reported that patients with SLE who chose to have less children than they had previously desired described concerns about inability to care for a child, damage from medications, and genetic transmission of their disease leading to the decision to pursue fewer pregnancies [6,7]. Anxieties regarding transmission and impaired ability to take care of children are among the primary worries of patients with lupus [8]. Nevertheless, this generally does not reflect a major concern of medical practitioners, leading to gaps in communication and discordant goals of care [9]. Despite intact fertility among SLE patients, there is morbidity associated with pregnancy. One study of 13,555 participants illustrated a maternal mortality 20-fold higher among women with SLE compared with healthy age-matched controls [10]. The rate of miscarriage is reported as 21.2% compared with 14% in a normal population. While the percentage of live births ranges from 85 to 90, pregnancy is considered a high-risk situation for female SLE patients [11]. Rate of stillbirth is 5 to 10 fold higher in patients with SLE than in the general population [12]. Preeclampsia is more common in SLE and may occur in up to 20% of lupus related pregnancies [13]. There is also increased risk for fetal morbidity, particularly preterm birth (12%) among SLE pregnancies compared with 4% in controls), intrauterine growth restriction, and neonatal lupus [11,14]. One third of pregnancies end in caesarian section [15]. Pregnancy morbidity is most strongly associated with increased disease activity in the six to 12 months prior to and during pregnancy, especially in cases with renal involvement [16,17]. Other risk factors in pregnancy include presence of hypocomplementemia, elevated levels of anti-DNA antibodies, antiphospholipid antibodies, and thrombocytopenia [18,19]. Moreover, pregnancy and the period immediate following delivery is a well-known time for lupus flare-ups [20]. While the hormonal influence on pregnancy is not fully understood due to the complicated interwoven hormonalinflammatory pathways, a disruption in the balance of Treg’s and Th17 helper cells and elevated IFN-γ appear to be players in generating poorer pregnancy outcomes [21,22]. Other maternal complications are related to the hypercoagulability of pregnancy augmented to the increased coagulation risk in SLE in general. During pregnancy, the risk of venous thromboembolism in patients with SLE is 62 out of 10,000 compared with 7.22 of 10,000 in the general population. Moreover, the risk of pulmonary embolism is significantly increased with an odds ratio of 9.76 [23]. In addition, the risk for stroke is 6.5-fold higher than that of healthy pregnant women [24]. In addition to the effect that SLE itself may impose on pregnancy and delivery, certain related medications are teratogenic. Moreover, cyclophosphamide can actually impair fertility, primarily by causing premature ovarian failure [25,26]. Accordingly, providers are advised to offer child-bearing women GnRH analogue therapy prior to initiation of cyclophosphamide [27]. Furthermore, observational studies have shown that most assisted reproductive techniques are safe and equally effective among women with SLE. There are no official guidelines regarding any specific protocol to be used among SLE patients aside from antithrombotic prophylaxis among women with antiphospholipid antibodies [28,29]. Among those patients who seek contraception, most options are available to women with SLE. Women with antiphospholipid lipid antibodies, even without a history of clotting or obstetric complication, and women with additional clotting risk factors including migraines and smoking, should be advised against use of combined hormones. However, aside from this advisement, most other contraceptive methods have proven to be safe in patients with SLE [30]. Nonetheless, despite vigorous research demonstrated the safety and benefits of contraception in patients with SLE, effective methods of birth control are widely underused. One study reported 55% of SLE patients had unprotected sex occasionally and another 23% engaged in unprotected sex most of the time [31]. Another glaring study found that 55% of patients with SLE using contraceptives regularly were using less-effective barrier methods only, even while on teratogenic medications [32]. These findings highlight the immense obstacle that patients with SLE face in receiving comprehensive care that meets their needs during their fertile years. Over the last decade, there is a growing understanding of the importance of early, open, and continual discussions on the topic of family planning between providers and patients. The ACR and EULAR have devised recommendations for providers to help stratify patients and offer appropriate counseling regarding contraception, conception, and assisted reproduction [33,34]. Despite the progress that has been achieved, future studies are warranted to determine how to best approach these patients and best counsel them through the complicated, interrelated pyschologic and medical issues that accompany SLE during the child-bearing stage.

scholarly journals Paternity in male kidney transplant recipients: a French national survey, the PATeRNAL study

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Annabel Boyer ◽  
◽  
Thierry Lobbedez ◽  
Mohamed Ouethrani ◽  
Angélique Thuillier Lecouf ◽  
...  
Keyword(s):  
General Population ◽  
Kidney Transplant ◽  
Pregnancy Outcomes ◽  
Immunosuppressive Agents ◽  
Warning Signal ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients ◽  
Still Births ◽  
Male Patients ◽  
The Impact

Abstract Background There is concern about the impact of immunosuppressive agents taken by male kidney transplant (KT) recipients on the risk of foetal malformations. The aim of our survey was to estimate the paternity rate and the outcomes of pregnancies fathered by kidney transplanted males. Methods This survey analysed 1332 male KT recipients older than 18 years, followed in 13 centres in France. A self-reported questionnaire was used to collect data on the patients, treatments at the time of conception and the pregnancy outcomes. Results The study included data on 349 children from 404 pregnancies fathered by 232 male KT recipients. The paternity rate was 17% (95% CI [15–20]). There were 37 (9%, 95% CI [7–12]) spontaneous abortions, 12 (3%, 95% CI [2–5]) therapeutic abortions, 2 (0.5%, 95% CI [0.1–1]) still births, and 13 (4%, 95% CI [2–6]) malformations reported. Compared to the general population, there was no difference in the proportion of congenital malformations nor unwanted outcomes whether the father was exposed or not to immunosuppressive agents. Conclusions This survey does not provide any warning signal that pregnancies fathered by male patients exposed to immunosuppressive agents, notably the debated MMF/MPA, have more complications than pregnancies in the general population.

Hypertension in long-term survivors of childhood renal cancers.

1989 ◽  
Vol 7 (7) ◽  
pp. 912-915 ◽  
Author(s):  
A F Kantor ◽  
F P Li ◽  
A J Janov ◽  
N J Tarbell ◽  
S E Sallan
Keyword(s):  
Wilms Tumor ◽  
Late Complication ◽  
Renal Surgery ◽  
Borderline Hypertension ◽  
Case Comparison ◽  
History Of ◽  
Family History Of Hypertension ◽  
Male Patients ◽  
Long Term Survivors

The prevalence of hypertension was investigated in 119 adults who have survived for up to 53 years following the diagnosis of renal cancer in childhood (Wilms' tumor, 116 patients; renal carcinoma, three patients). Twenty-four (20%) have developed definite or borderline hypertension, as compared with 18.1 cases expected based on US population rates (relative risk [RR], 1.3; 95% confidence interval [CI], 0.9 to 2.0; P = .20). This nonsignificant excess is due to the heightened prevalence of definite hypertension among one subgroup of male patients. The findings are not explained by cigarette smoking, obesity, age, and stage at diagnosis of Wilms' tumor, or family history of hypertension. A case-comparison analysis within the cohort showed no consistent hypertensive effect associated with radiation therapy dose, radiotherapy concurrent with dactinomycin chemotherapy, or extent of renal surgery. Hypertension is not a common late complication of Wilms' tumor in our patients.

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