Klin Padiatr 2014; 226 - P_44
DOI: 10.1055/s-0034-1371165

Fertility Testing in Young Men After Successful Treatment of Hodgkin's Lymphoma with Procarbazine-Free Combination Regimen within the GPOH-HD 2002 Trial

J Conrad 1, M Stiefel 1, H Behre 2, H Jürgens 3, C Kramm 4, R Schneppenheim 5, A Attarbaschi 6, G Ebetsberger-Dachs 7, E Bergstraesser 8, D Körholz 1, C Mauz-Körholz 1
  • 1Martin-Luther University Medical Center, Dept. of Pediatrics, Halle (Saale), Germany
  • 2Martin-Luther University Medical Center, Department of Reproductive Medicine and Andrology, Halle (Saale), Germany
  • 3Westfälische Wilhelms-Universität, Department of Pediatric Hematology and Oncology, Münster, Germany
  • 4Georg-August-Universität, Department of Pediatric Hematology and Oncology, Göttingen, Germany
  • 5University Medical Center, Department of Pediatric Hematology and Oncology, Hamburg, Germany
  • 6Medical University, St Anna Children's Hospital, Dept. of Pediatric Hematology and Oncology, Vienna, Austria
  • 7Gesundheits- und Spitals-AG, Department of Pediatrics, Linz, Austria
  • 8Universitäts-Kinderspital, Department of Pediatric Hematology and Oncology, Zürich, Switzerland

Purpose: Male infertility is a frequent late effect after procarbazine-containing chemotherapy regimens for treatment of pediatric Hodgkin Lymphoma (HL). The GPOH-HD 2002 trial aimed at preservation of fertility by substituting procarbazine by dacarbazine in male patients. Two years after end of treatment fertility surrogate parameters (FSH, Inhibin B) and semen samples were analyzed.

Patients and Methods: All boys received two induction cycles of OEPA (vincristine, etoposide, prednisone and doxorubicine) instead of standard OPPA (vincristine, procarbazin, prednisone and doxorubicine). Patients in intermediate (treatment group 2, TG2) and advanced stages (treatment group 3, TG3) received 2 or 4 consolidation cycles COPDAC (cyclophosphamide, vincristine, prednisone and dacarbazine) instead of standard COPP (cyclophosphamide, vincristine, prednisone and procarbazine). All TG2 and TG3 patients received 19.8 Gy involved field radiotherapy. Boys above 14 years of age and Tanner stage ≥4, in first remission two years after end of treatment (EOT) in TG2 or TG3 were eligible for the fertility study.

Results: Of 287 boys in the GPOH-HD 2002 trial 108 fulfilled all inclusion criteria. 34 patients at a median age of 18.6 (15 – 23) years were enrolled within a 4-year-recruitment period. Four patients were excluded from the analysis since their follow-up time was < 2 years after EOT. FSH was evaluable in 29/30 patients and was within the normal range in 24/29 (82.75%) patients, 3 patients had elevated FSH. Inhibin B was analysed in 25/29 patients, and 4/25 had lowered Inhibin B values. 21 semen samples could be collected, 6 were assessed as completely normal, 11 showed mild to moderate impairment and 4 revealed severe alterations according to the WHO 2010 criteria.

Conclusion: Following procarbazine-free chemotherapy for HL male fertility parameters (FSH, Inhibin B) were mostly normal or only moderately impaired, whereas ejaculate analysis revealed more often alterations. To further confirm these results, fertility analyses will be carried out within the EuroNet-PHL-C1 trial where procarbazine- and dacarbazine- containing regimens were randomized among trial subjects.