Fertility in Male Patients with Hodgkin’s Disease - Results from the German Hodgkin Lymphoma Study Group (GHSG).

Background:

Treatment results in Hodgkin Disease (HD) have improved tremendously over the last two decades. Therefore long term sides effects of therapy as infertility are of growing importance. However, patients (pts) with HD have increased risk for inadequate semen quality even prior to treatment. To investigate the influence of disease and therapy on the fertility status in pts with HD we performed semen and hormone analysis before and after treatment.

Patients and Methods:

All analysis were evaluated in pts with first diagnosis of HD enrolled into trials of the GHSG between 1988 and 2002, in 40 centers in Europe. Pts had no history of chemotherapy or radiotherapy. All analysis were evaluated according to WHO-guidelines.

Results:

We included 243 male pts with a median age of 26,5 years (range 16–57,5 years). At first diagnosis 138 pts were in clinical stage (CS) I/II, 105 in CS III/IV, and systemic symptoms were present in 106 pts. 202 pts underwent fertility screening before therapy: normospermia was diagnosed in 40 (20%) pts and 162 (80%) had inadequate semen quality. Normal values of FSH, LH, and testosterone were found in 140/151 (93%), 99/125 (79%), and 84/101 (83%) of pts respectively. 112 pts underwent at last one fertility screening after therapy. Treatment consisted of chemotherapy alone in 10 pts, in 9 pts of radiotherapy alone and in 93 pts of combined modality. In 40 (36%) pts a recovery of spermatogenesis was observed. Normal values of FSH, LH, and testosterone after treatment were found in 32/63, 40/51, and 36/40 pts respectively. Table 1 shows time of onset of spermatogenesis and normal values of fertility hormones after the end of therapy.

Table 1

Recovery from azoospermia was observed in 8 (89%) pts treated with radiotherapy, in 1 (10%) pt treated with chemotherapy alone and in 31 (33%) pts treated with combined modality. Recovery rate from azoospermia was lower in pts treated with alkylating agents, BEACOPP chemotherapy, with systemic symptoms and elevated BSG.

Conclusions:

We confirmed that HD pts had inadequate semen quality even prior to treatment. The majority of pts had azoospermia after treatment, but recovery of spermatogenesis was observed, in general 2 years after the end of therapy. Hormone values usually recovered in the first two years. Patient treated with radiotherapy alone recovered in higher frequency. A detailed analysis (including multivariate analyses) will be presented at the annual meeting.