Fertility after Treatment of Pediatric Hodgkins Lymphoma [HL]

To identify the long-term effect of chemo-radiotherapy on fertility in Hodgkins disease (HD) patients regularly attending the pediatric oncology clinic of NCI, 42 long-term survivors (LTS) (33 males and 9 females) were studied, together with 26 newly-diagnosed (ND) HD patients (15 males and 11 females) and 28 healthy controls. During 3 years period, all patients subjected to through clinical history/ examination. Files of LTS were revised for date of diagnoses, original site(s), stage, histopathological subtypes and dose/ duration of therapy. Clinical examination was done with laying stress on visceromegaly and the presence of lymphadenopathy. Lab investigations included CBC, ESR, bone marrow biopsy and fertility hormones. Radiodiagnostic studies (plain X-ray, abdominal sonography, and chest/ abdominal/ pelvic CT scans) were done whenever indicated. In LTS the mean age was 14.9±3.4 yrs. (median 15.5 yrs) versus 9.5±3.7 yrs . (median 8.5 yrs) in ND patients. In LTS, treatment modalities included radiotherapy [RT] alone (2.4%), chemotherapy [CTH] alone [MOPP, ABVD, OPPA, and COPP] (26.2%) or combination chemoradiotherapy (71.4%). The mean follow-up time was 7.47±2.19 yrs. (median 6.75 ND 6.75 yrs .). Increased incidence of high luteinizing hormone (LH) and follicle -stimulating hormone (FSH) and testosterone levels was found in patients who received therapy for one year versus those who received longer period, with no statistically significant difference. However, the mean values of pre-pubertal male LH and post- pubertal male LH and FSH were statistically significant difference among the three groups. Azoospermia was seen in 10/11 of LTS, with low testosterone in 2 only. Finally, the study documented that there is Azoospermia with affection of fertility hormones (in males)in LTS-HD patients. Recommendations regarding the comprehensive follow-up of therapy for HD were discussed. Endocrine consultation is needed for Survivors with concerns regarding fertility. Intervention strategies and new evidence-based surveillance of the long -term effects like screening for early detection of late effects, and chemo prevention are needed for dealing with HD, especially in children.