Preservation of gonadal function following chemotherapy protocols with acvd and acvd-BV in adults diagnosed with advanced-stage Hodgkin lymphoma: A single center experience. Free

Authors:

Maryam Almutairi ¹²³⁴, Mohammed AlHarbi¹²³⁴, Abdullah Alsaleh¹²³⁴, Mohsen Alzahrani¹²³⁴, Bader Alahmari¹²³⁴, Hind Salama¹²³⁴, Abdulrahman Alraizah¹²³⁴, Ayman Ibrahim¹²³⁴, Mohammed Bakkar¹²³⁴, Ayel Yahya¹²³⁴, Khalid Aldosari¹²³⁴, Sumayyah Altamimi¹²³⁴, Abdul Rauf Ghori¹²³⁴, Mazin Ahmed¹²³⁴, Mohammed Snallah¹²³⁴, Naveed Qureshi¹²³⁴ May-Anne Mendoza¹²⁴, Naila Shaheen¹²⁴, Ayman Alhejazi¹²³⁴ and Ahmed Alaskar¹²³⁴

1. King Abdullah International Medical Research Center

2. King Saud bin Abdulaziz University for Health Sciences

3. Department of Oncology, King Abdulaziz Medical City, Riyadh, Ministry of the National Guard, Health Affairs

4. Saudi Society of Blood and Marrow Transplantation (SSBMT)

5. Department of Oncology, Prince Mohammed Medical City, Aljouf, Ministry of Health

Corresponding Author:

Ahmed Alaskar. Email:

Background:

ABVD (Adriamycin, Bleomycin, Vinblastine and Dacarbazine) is commonly used to treat Hodgkin lymphoma (HL) with a relatively lower risk of gonadal toxicity. However, lung toxicity particularly from Bleomycin leads to a common practice of omitting it with no or less effect on efficacy.

ACVD (Adriamycin 25 mg/m², Cyclophosphamide 400 mg/m², Vinblastine 6 mg/m² (max 10 mg) and Dacarbazine 375 mg/m²) is a modified chemotherapy regimen from ABVD given IV on day 1 and day 15 and repeated every 28 days for 6 cycles, replacing bleomycin with low dose cyclophosphamide to further optimize efficacy and reduce pulmonary and gonadal toxicity. Brentuximab vedotin is added to ACVD (ACVD-BV) in those cases of positive PET following 2 cycles of ACVD. It has been used in advanced-stage HL (including stage II with bulky disease) as defined by Ann-Arbor staging system for HL . This study evaluates gonadotoxicity in adult HL patients treated with ACVD and ACVD-BV regimens.

Methods:

A retrospective cohort study was conducted among HL patients aged ≥17 years who received either ACVD (n=45) or ACVD-BV (n=11) chemotherapy protocols. Patients were followed for a median duration of 12 to 18 months from the initiation of treatment. Collected data included demographics, semen analysis results, natural return of menses and occurrence of natural pregnancy in female patients or spouses of male patients.

Results:

A total of 56 patients were included. 22 (39%) were females (mean age: 30 years, range 17–58) : 2 were post-menopausal so their gonadal function is unknown, 4 became pregnant and 16 resumed their menses spontaneously). 34 (61%) were males (mean age: 32.7 years, range 17–66) : 6 got their spouses pregnant, 20 had normal sperm analysis post-chemotherapy, 8 had no assessment so their gonadal function is unknown. Hence, in total 46 (82%) patients who underwent chemotherapy treatment using either ACVD or ACVD-BV have gained their gonadal function. No one reported to have failure of gonadal function, and 10(18%) with unknown status of their gonadal function.

Sperm banking was performed for 18/34 (53%) males before starting chemotherapy, and only 3/22 (13.617%) females received leuprorelin (GnRH agonist) during the chemotherapy.

Conclusion:

This study shows a favorable advantage of ACVD /ACVD-BV chemotherapy in treating advanced-stage HL where majority of cases gained their gonadal functions. However, limitations include retrospective design, missing baseline gonadal function evaluation, particularly semen analyses, and inconsistent hormone level documentation. Fertility preservation strategies should be routinely discussed and documented prior to treatment initiation. Long-term prospective studies are recommended to more accurately assess gonadal function post-treatment.