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Keywords:

  • late effects of therapy;
  • fertility;
  • lymphomas

We read with great interest the report of Meissner et al on parenthood outcomes following cyclophosphamide, doxorubicin, vincristine, prednisolone (CHOP) or CHOP plus etoposide (CHOEP) chemotherapy for non-Hodgkin lymphoma. The apparent absence of any significant effect on planned parenthood is reassuring. Although retrospective, the study's findings are strengthened by their approach in which detailed reasons for potential childlessness are explored, including social and psychological factors. It is of considerable interest that one third of the respondents who did not go on to have more children, despite stating that this was their intent prior to their lymphoma diagnosis, gave ‘fear of recurrence’ as their reason for not trying. This concern is just one of many that may be addressed by comprehensive psychological aftercare. Our own study found overall rates of childlessness in female survivors of haematological malignancy to be higher than in the general population (Greaves et al, 2013), probably explained by the longer duration of follow-up and diversity of treatments for our responding cohort of patients, many of whom will have been exposed to regimes deemed excessively intensive by contemporary standards. This new study has the advantage of investigating a more homogeneous group of patients being treated in a single clinical trial with only CHOP-based chemotherapy, which remains the core cytotoxic component of current treatment regimes.

CHOP and CHOEP are indeed perceived by many treating physicians to carry a greater risk of infertility than has been borne out by this study. However, there remains adequate evidence that the risk is not negligible (Watson et al, 1985; Pryzant et al, 1993). Excess anxiety around potential infertility should not result in a delay, or a reduction in the intensity of proven efficacious treatment. However a proper discussion around fertility should always be undertaken at diagnosis, and it remains good practice to secure potential future parenthood with fertility interventions, such as sperm banking, as long as these have proven efficacy and can be undertaken without compromising treatment. Meissner et al have provided invaluable and robust data to inform the pretreatment counselling that is too often based on anecdotal and outdated evidence.

References

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  2. References
  • Greaves, P., Sarker, S., Chowdhury, K., Johnson, R., Matthews, J., Matthews, R., Smith, M., Korszun, A., Gribben, J.G. & Lister, T.A. (2013) Fertility and sexual function in long-term survivors of haematological malignancy: using patient-reported outcome measures to assess a neglected area of need in the late effects clinic. British Journal of Haematology, 164, 526535.
  • Pryzant, R.M., Meistrich, M.L., Wilson, G., Brown, B. & McLaughlin, P. (1993) Long-term reduction in sperm count after chemotherapy with and without radiation therapy for non-Hodgkin's lymphomas. Journal of Clinical Oncology, 11, 239247.
  • Watson, A.R., Rance, C.P. & Bain, J. (1985) Long term effects of cyclophosphamide on testicular function. British Medical Journal (Clinical Research Ed.), 291, 14571460.