Caroline E. Weibull1, Anna L. V. Johansson1,2, Sandra Eloranta3, Karin E. Smedby3,4, Magnus Björkholm4, Paul C. Lambert1,5, Paul W. Dickman1, Ingrid Glimelius3,6
1Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden,2Cancer Registry of Norway, Oslo, Norway,3Department of Medicine, Clinical Epidemiology Unit, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden,4Department of Medicine, Division of Hematology, Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden,5Biostatistics Research Group, Department of Health Sciences, University of Leicester, Leicester, UK,6Department of Immunology, Genetics and Pathology, Clinical and Experimental Oncology, Uppsala University and Uppsala Akademiska Hospital, Sweden
Purpose: With excellent cure rates for young Hodgkin lymphoma (HL) patients, there is an increasing number of female HL survivors interested in becoming pregnant. Here we report childbearing among contemporarily treated HL survivors in comparison to the general population.
Material and Methods: Using Swedish registers, 449 women (aged 18–40 years) diagnosed with HL 1992–2009 and in remission nine months following diagnosis were identified. Patients were age- and calendar-year-matched to 2,210 population comparators. Rates of first post-diagnosis childbirth were calculated. Hazard ratios (HRs) with 95% confidence intervals (CIs) were estimated for different follow-up periods using Cox regression. Cumulative probabilities of first childbirth were calculated in the presence of the competing risk of death/relapse.
Results: Twenty-two percent of relapse-free HL patients had a child during follow-up and first childbirth rates increased over time; from 40.2 per 1,000 person-years (1992–1997) to 69.7 (2004–2009). For comparators, rates remained stable (70.1 per 1,000 person-years). Patients diagnosed 2004–2009 had a cumulative probability of childbirth similar to comparators. Three years or more after diagnosis, no differences in childbirth rates were observed between patients and comparators, irrespective of stage or treatment. Patients receiving 6–8 BEACOPP had a lower childbirth rate than comparators during the first three years (HR = 0.23, 95% CI: 0.06–0.94) (Figure 1), as did patie.nts who received 6–8 courses of chemotherapy and radiotherapy (HR = 0.21, 95% CI: 0.07–0.65).
Conclusion: Childbearing potential among female HL survivors has improved over time, and rates three years after diagnosis in contemporarily treated patients are, in the absence of relapse, similar to those in the general population, irrespective of stage and treatment.
The full length paper is in press, Journal of Clinical Oncology 2018