Abstract
We assessed fertility/gonadal function in premenopausal women treated with dose-adjusted EPOCH-Rituximab for untreated primary mediastinal B-cell lymphoma (PMBL). Eligible patents were ≤ 50 years and premenopausal. Serial reproductive histories were obtained and hormonal assays were performed on serum samples before, at the end of treatment and 4-18 months later. Twenty-eight eligible women had a median age (range) of 31 (21-50) years and were followed a median of 7.3 years. Of 23 patients who completed a questionnaire, 19 (83%) were and four were not menstruating prior to chemotherapy. Amenorrhea developed in 12 patients during chemotherapy. At > 1-year follow-up, 14/19 (74%) patients were menstruating, all < 35 years old, and six (43%) of these patients delivered healthy children. Hormonal assays showed ovarian dysfunction during chemotherapy in all patients with varying recovery at 4-18 months after treatment. Fertility was preserved in most women with ovarian failure confined to patients > 40 years old.
Keywords:
Aggressive B-cell lymphoma; DA-EPOCH-R; fertility; fertility following chemotherapy; primary mediastinal B-cell lymphoma.
MeSH terms
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Adult
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Antibodies, Monoclonal, Murine-Derived / adverse effects
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Antibodies, Monoclonal, Murine-Derived / therapeutic use
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Antineoplastic Combined Chemotherapy Protocols / adverse effects*
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Antineoplastic Combined Chemotherapy Protocols / therapeutic use
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Biomarkers
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Cyclophosphamide / adverse effects
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Cyclophosphamide / therapeutic use
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Doxorubicin / adverse effects
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Doxorubicin / therapeutic use
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Etoposide / adverse effects
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Etoposide / therapeutic use
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Female
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Fertility / drug effects*
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Follow-Up Studies
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Gonadal Steroid Hormones / blood
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Humans
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Lymphoma, B-Cell / diagnosis
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Lymphoma, B-Cell / drug therapy
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Lymphoma, B-Cell / physiopathology*
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Mediastinal Neoplasms / diagnosis
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Mediastinal Neoplasms / drug therapy
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Mediastinal Neoplasms / physiopathology*
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Menstruation / drug effects
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Middle Aged
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Prednisone / adverse effects
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Prednisone / therapeutic use
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Pregnancy
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Pregnancy Outcome
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Rituximab / administration & dosage
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Vincristine / adverse effects
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Vincristine / therapeutic use
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Young Adult
Substances
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Antibodies, Monoclonal, Murine-Derived
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Biomarkers
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Gonadal Steroid Hormones
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R-CHOP protocol
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Rituximab
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Vincristine
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Etoposide
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Doxorubicin
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Cyclophosphamide
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Prednisone