No evidence for the benefit of gonadotropin-releasing hormone agonist in preserving ovarian function and fertility in lymphoma survivors treated with chemotherapy: Final long-term report of a prospective randomized trial

Isabelle Demeestere, Pauline Brice, Fedro A. Peccatori, Alain Kentos, Jehan Dupuis, Pierre Zachee, Olivier Casasnovas, Eric Van Den Neste, Julie Dechene, Viviane De Maertelaer, Dominique Bron, Yvon Englert

Research output: Contribution to journalArticle

Abstract

Purpose: We have reported previously that after 1-year follow up, gonadotropin-releasing hormone agonist (GnRHa) did not prevent chemotherapy-induced premature ovarian failure (POF) in patients with lymphoma, but may provide protection of the ovarian reserve. Here, we report the final analysis of the cohort after 5 years of follow up. Patients and Methods: A total of 129 patients with lymphoma were randomly assigned to receive either triptorelin plus norethisterone (GnRHa group) or norethisterone alone (control group) during chemotherapy. Ovarian function and fertilitywere reported after 2, 3, 4, and 5 to 7 years of followup. The primary end pointwas POF, defined as at least one follicle-stimulating hormone value of > 40 IU/L after 2 years of follow up. Results: Sixty-seven patients 26.21 ± 0.64 years of age had available data after a median follow-up time of 5.33 years in the GnRHa group and 5.58 years in the control group (P = .452). Multivariate logistic regression analysis showed a significantly increased risk of POF in patients according to age (P = .047), the conditioning regimen for hematopoietic stemcell transplant (P = .002), and the cumulative dose of cyclophosphamide > 5 g/m2 (P = .019), but not to the coadministration of GnRHa during chemotherapy (odds ratio, 0.702; P = .651). The ovarian reserve, evaluated using anti-Müllerian hormone and follicle-stimulating hormone levels, was similar in both groups. Fifty-three percent and 43% achieved pregnancy in the GnRHa and control groups, respectively (P = .467). Conclusion: To the best of our knowledge, this is the first long-term analysis confirming that GnRHa is not efficient in preventing chemotherapy-induced POF in young patients with lymphoma and did not influence future pregnancy rate. These results reopen the debate about the drug's benefit in that it should not be recommended as standard for fertility preservation in patients with lymphoma.

Original languageEnglish
Pages (from-to)2568-2574
Number of pages7
JournalJournal of Clinical Oncology
Volume34
Issue number22
DOIs
Publication statusPublished - Aug 1 2016

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ASJC Scopus subject areas

  • Cancer Research
  • Oncology

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