Late Effects from Childhood�/�Adolescent Hodgkin Lymphoma Therapy
A regimen used by the former Pediatric Oncology Group (POG) included cyclophosphamide but no procarbazine (ABVE-PC). In this regimen, cyclophosphamide was given at 800 mg/m2 /course for three to five cycles. A few studies have evaluated male fertility following cyclophosphamide-containing regimens given to children and young adults with sarcomas and other cancers.[7,8,9] The studies have suggested that the incidence of sterility will be low if the cyclophosphamide dose is less than 7.5 g/m2. The level of inhibin B in blood seems to be inversely correlated with FSH levels. Some patients with normal FSH levels may have azoospermia on semen analysis.
There are few published data concerning the incidence of ovarian failure following chemotherapy for female children and young adults with Hodgkin lymphoma. It appears that the ovaries of children and adolescents are less sensitive to the effects of alkylating agents than are the ovaries of older women. Most females will attain menses (prepubertal at treatment) or regain normal menses (pubertal at treatment) unless pelvic radiation therapy is given without oophoropexy. The incidence of early menopause in young female survivors of Hodgkin lymphoma is being studied, and may be as high as 37%.[11,12] A small study of patients treated with ABVD, suggests that there is no effect on fertility. Another study of 12 female childhood Hodgkin lymphoma survivors showed that VAMP chemotherapy and low-dose involved-field radiation seems to have a minimal impact on female fertility as 14 healthy babies were born to these women.
The largest database for thyroid abnormalities is that of the Childhood Cancer Survivor Study. The cohort of 13,674 patients included 1,791 survivors of childhood Hodgkin lymphoma. For patients with full data, 92 patients received chemotherapy alone, and 1,210 patients received radiation therapy (with or without chemotherapy). Only 15% of patients receiving radiation had doses less than 20 Gy. By self-report, hypothyroidism occurred within 20 years from diagnosis in 7.6% of unirradiated patients, 30% of those receiving less than 35 Gy and 50% of those receiving more than 35 Gy. Although no thyroid cancers were noted in patients receiving less than 25 Gy, overall, there was an 18-fold increased risk of thyroid cancer in survivors of pediatric Hodgkin lymphoma. The risk of hypothyroidism in white patients is 2.5 times the risk in black patients. In a study of 47 survivors of pediatric Hodgkin lymphoma who received neck irradiation (22.5-40 Gy), ultrasonography revealed atrophy in 45 patients and goiters in two patients. Twenty patients had a focal abnormality (15 multiple, 5 solitary). Five patients had a lesion larger than 1 cm. Ten patients underwent surgery, and five patients had thyroid carcinoma diagnosed.