Hodgkin's-Lymphoma

Detailed information and a list of references can be found in Chapter 2.9 of the FertiPROTEKT book, "Indications and fertility preservation methods for oncological and non-oncological disorders", which can be downloaded free of charge.

 

Prognosis

2-3 new cases per 100,000 people occur annually and men are slightly more commonly affected with the ratio 3: 2. 2200 new cases were recorded in Germany in 2010 and young people are often affected.

Over recent decades, Hodgkin's lymphoma has developed from an incurable disease to one of the most treatable malignancies in adults with outstanding 5-year survival rates.

+ SURVIVAL RATES IN WOMEN AND MEN ACCORDING TO THE AGE AT DIAGNOSIS


Age at initial diagnosis (years) 5-year survival rate 15-year survival rate
18-29 96% 94%
30-39 95% 91%
40-49 93% 87%

 

damage to ovaries and testes caused by Chemotherapy and/or radiotherapy

The chemotherapy regimens used in Hodgkin's lymphoma have differing effects on the gonads. The so-called intensive escalated BEACOPP therapy has a higher toxicity than the ABVD regimen. We also know that the damaging effect is greater in older women, since they already have fewer eggs than younger women.

+ PERCENTAGE OF WOMEN WHO STILL HAD A REGULAR MENSTRUAL CYCLE AFTER CHEMOTHERAPY - ACCORDING TO THE AGE AND THE ADMINISTERED CHEMOTHERAPY

Age Time of assessment 2x ABVD ABVD plus 2x escalated BEACOPP 6x escalated BEACOPP
18-29 years Immediately after chemotherapy 94% 100% 88%
At the time of questioning (average: 46 months after treatment) 88% 95% 81%
30-45 years Immediately after chemotherapy 97% 90% 55%
At the time of questioning (average: 46 months after treatment) 95% 75% 40%

Chemotherapy particularly affects sperm development in men. The impact of the therapy on testosterone production, however, is low. Irradiation of the testes is very harmful, even with minimal doses. However, irradiation of the testicular area is rarely necessary.

 

Risk of metastasis in the gonads

Several studies have systematically tried to detect tumour cells in frozen ovarian tissue. Evidence of Hodgkin’s lymphoma cells in ovarian tissue is hardly ever found, even in high-grade tumour stages. Hodgkin lymphoma is classified as a disease with a low risk of metastasis.

 

Risks of fertility preservation

Fertility preservation measures are usually only associated with low risks in Hodgkin's lymphoma patients. The tumour cells are not dependent on hormones and the time available to carry out all procedures is usually long enough. The risk of lymphoma cells being found in the gonads is low.

 

practical approach

Patients should be referred to a reproductive medical centre as soon as possible to allow a sufficient time frame for the implementation of fertility protection measures.  A referral can be made even before the chemotherapy regimen is agreed.

 

Basic procedure for performing fertility protection measures in women with Hodgkin's lymphoma (POI = complete loss of ovarian function). As it is a simple procedure, men should generally be advised to have their sperm frozen, regardless of age and chemotherapy regimen.