Risk of premature menopause after treatment for Hodgkin's lymphoma

2.50
Hdl Handle:
http://hdl.handle.net/11287/593818
Title:
Risk of premature menopause after treatment for Hodgkin's lymphoma
Authors:
Swerdlow, A. J.; Cooke, R.; Bates, A.; Cunningham, D.; Falk, S. J.; Gilson, D.; Hancock, B. W.; Harris, S. J.; Horwich, A.; Hoskin, P. J.; Linch, D. C.; Lister, A.; Lucraft, H. H.; Radford, J.; Stevens, A. M.; Syndikus, I.; Williams, M. V.; England,; Wales Hodgkin Lymphoma Follow-up, Group; Goodman, Andrew
Abstract:
BACKGROUND: Modern treatment of Hodgkin's lymphoma (HL) has transformed its prognosis but causes late effects, including premature menopause. Cohort studies of premature menopause risks after treatment have been relatively small, and knowledge about these risks is limited. METHODS: Nonsurgical menopause risk was analyzed in 2127 women treated for HL in England and Wales at ages younger than 36 years from 1960 through 2004 and followed to 2003 through 2012. Risks were estimated using Cox regression, modified Poisson regression, and competing risks. All statistical tests were two-sided. RESULTS: During follow-up, 605 patients underwent nonsurgical menopause before age 40 years. Risk of premature menopause increased more than 20-fold after ovarian radiotherapy, alkylating chemotherapy other than dacarbazine, or BEAM (bis-chloroethylnitrosourea [BCNU], etoposide, cytarabine, melphalan) chemotherapy for stem cell transplantation, but was not statistically significantly raised after adriamycin, bleomycin, vinblastine, dacarbazine (ABVD). Menopause generally occurred sooner after ovarian radiotherapy (62.5% within five years of >/=5 Gy treatment) and BEAM (50.9% within five years) than after alkylating chemotherapy (24.2% within five years of >/=6 cycles), and after treatment at older than at younger ages. Cumulative risk of menopause by age 40 years was 81.3% after greater than or equal to 5Gy ovarian radiotherapy, 75.3% after BEAM, 49.1% after greater than or equal to 6 cycles alkylating chemotherapy, 1.4% after ABVD, and 3.0% after solely supradiaphragmatic radiotherapy. Tables of individualized risk information for patients by future period, treatment type, dose and age are provided. CONCLUSIONS: Patients treated with HL need to plan intended pregnancies using personalized information on their risk of menopause by different future time points.
Citation:
J Natl Cancer Inst. 2014 Aug 19;106(9)
Publisher:
Oxford Journals
Journal:
Journal of the National Cancer Institute
Issue Date:
1-Sep-2014
URI:
http://hdl.handle.net/11287/593818
DOI:
10.1093/jnci/dju207
PubMed ID:
25139687
Additional Links:
http://jnci.oxfordjournals.org/cgi/pmidlookup?view=long&pmid=25139687
Note:
This article is available via Open Access. Please click on the 'Additional Link' above to access the full-text.
Type:
Journal Article; Research Support, Non-U.S. Gov't
Language:
eng
ISSN:
1460-2105
Appears in Collections:
2014 RD&E publications; Oncology

Full metadata record

DC FieldValue Language
dc.contributor.authorSwerdlow, A. J.en
dc.contributor.authorCooke, R.en
dc.contributor.authorBates, A.en
dc.contributor.authorCunningham, D.en
dc.contributor.authorFalk, S. J.en
dc.contributor.authorGilson, D.en
dc.contributor.authorHancock, B. W.en
dc.contributor.authorHarris, S. J.en
dc.contributor.authorHorwich, A.en
dc.contributor.authorHoskin, P. J.en
dc.contributor.authorLinch, D. C.en
dc.contributor.authorLister, A.en
dc.contributor.authorLucraft, H. H.en
dc.contributor.authorRadford, J.en
dc.contributor.authorStevens, A. M.en
dc.contributor.authorSyndikus, I.en
dc.contributor.authorWilliams, M. V.en
dc.contributor.authorEngland,en
dc.contributor.authorWales Hodgkin Lymphoma Follow-up, Groupen
dc.contributor.authorGoodman, Andrewen
dc.date.accessioned2016-01-19T12:35:19Zen
dc.date.available2016-01-19T12:35:19Zen
dc.date.issued2014-09-01en
dc.identifier.citationJ Natl Cancer Inst. 2014 Aug 19;106(9)en
dc.identifier.issn1460-2105en
dc.identifier.pmid25139687en
dc.identifier.doi10.1093/jnci/dju207en
dc.identifier.urihttp://hdl.handle.net/11287/593818en
dc.description.abstractBACKGROUND: Modern treatment of Hodgkin's lymphoma (HL) has transformed its prognosis but causes late effects, including premature menopause. Cohort studies of premature menopause risks after treatment have been relatively small, and knowledge about these risks is limited. METHODS: Nonsurgical menopause risk was analyzed in 2127 women treated for HL in England and Wales at ages younger than 36 years from 1960 through 2004 and followed to 2003 through 2012. Risks were estimated using Cox regression, modified Poisson regression, and competing risks. All statistical tests were two-sided. RESULTS: During follow-up, 605 patients underwent nonsurgical menopause before age 40 years. Risk of premature menopause increased more than 20-fold after ovarian radiotherapy, alkylating chemotherapy other than dacarbazine, or BEAM (bis-chloroethylnitrosourea [BCNU], etoposide, cytarabine, melphalan) chemotherapy for stem cell transplantation, but was not statistically significantly raised after adriamycin, bleomycin, vinblastine, dacarbazine (ABVD). Menopause generally occurred sooner after ovarian radiotherapy (62.5% within five years of >/=5 Gy treatment) and BEAM (50.9% within five years) than after alkylating chemotherapy (24.2% within five years of >/=6 cycles), and after treatment at older than at younger ages. Cumulative risk of menopause by age 40 years was 81.3% after greater than or equal to 5Gy ovarian radiotherapy, 75.3% after BEAM, 49.1% after greater than or equal to 6 cycles alkylating chemotherapy, 1.4% after ABVD, and 3.0% after solely supradiaphragmatic radiotherapy. Tables of individualized risk information for patients by future period, treatment type, dose and age are provided. CONCLUSIONS: Patients treated with HL need to plan intended pregnancies using personalized information on their risk of menopause by different future time points.en
dc.language.isoengen
dc.publisherOxford Journalsen
dc.relation.urlhttp://jnci.oxfordjournals.org/cgi/pmidlookup?view=long&pmid=25139687en
dc.titleRisk of premature menopause after treatment for Hodgkin's lymphomaen
dc.typeJournal Articleen
dc.typeResearch Support, Non-U.S. Gov'ten
dc.identifier.journalJournal of the National Cancer Instituteen
dc.description.noteThis article is available via Open Access. Please click on the 'Additional Link' above to access the full-text.en

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