S. Viviani, E. Somigliana, F. Filippi, F. Landi, A. Paffoni, G. Mangili, R. Mazza, E. Papaleo, C. Sigismondi, L. Devizzi, A. Dodero, L. Farina, P. Corradini
Department of Medical Oncology and Hematology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Division of Gynecology and Obstetrics, Infertility Unit, Fondazione Ca‘ Granda Ospedale Maggiore Policlinico, Milan, Department of Obstetrics and Gynecology, San Raffaele Hospital, Milan, Department of Hemato-Oncology, Humanitas Cancer Center, Rozzano
The majority of patients with classical Hodgkin lymphoma (HL) will be cured with modern chemotherapy (CT) or combined modality. At least half of the patients failing front-line therapy will be cured by salvage high-dose CT and autologous stem cell transplant. Treatment regimens may include alkylating agents, procarbazine, cisplatin or its analogues, which lead to severe ovarian reserve damage and to infertility, responsible of impairment of quality of life in young female patients of chilbearing age.
Mature oocyte preservation is one of the most successful fertility preservation techniques and it is admitted by italian legal rules.
Aims of study: To evaluate in a prospective observational study the rate of acceptability and feasibility of mature oocytes cryopreservation in female patients, aged ≥ 18 and ≤38 years, with newly diagnosed HL.
Methods: Adult female patients aged ≥ 18 and ≤38 years with histologically proven untreated HL, were offered gynecological counseling and assessment of ovarian reserve by ultrasound (US) antral follicle count and AMH serum levels measurement. A random start protocol for ovarian hyperstimulation was adopted and retrieval of oocytes was performed with intravenous sedation under US guidance. The time intervals between biopsy, first hematological visit, first gynecological counseling, oocytes retrieval and CT start, as well as the history of menstrual cycles and/or spontaneous pregnancies and PFS were recorded.
Results: From July 2013 and February 2018, 27 patients, median age 25 years were enrolled. 19 (70%) patients, without contraindications, accepted to undergo ovarian stimulation. The median number of mature oocytes retrieved and cryopreserved was 16 (range, 4–36) and 14 (range, 4–23), respectively. Median time from first hematological visit and oocytes retrieval was 18 days. Median time from oocytes retrieval and CT start was 4 days. All patients who had completed CT (22 out of 23), are alive and in continuous CR at a median follow-up of 34 months (range, 7–60).
Conclusions: Ovarian hypoerstimulation with random start protocol and oocytes retrieval, one of the most successful fertility technique, is feasible in young female diagnosed with HL. The median delay in CT start of ≤15 days has no detrimental effect on long-term outcome.