ESPE Yearbook of Paediatric Endocrinology

fragaudio@alice.it British Journal of Haematology, 2022, 196, 110–115. PMID: 34462914.

Brief Summary: This prospective single-centre study evaluated fertility in men diagnosed with Hodgkin lymphoma (HL) by sperm analysis, in order to identify clinical and biological characteristics correlated with fertility status. Only 28% of men showed normal sperm analysis.

Previous studies in patients with HL reported reduced fertility rates already present at diagnosis and prior to any treatment, indicating that HL-associated factors may contribute to infertility (1- 3). In addition, it is well known that high-dose of alkylating agents are responsible of germ cell damage at several steps of the differentiation and maturation of these cells.

This study included 100 HL patients diagnosed between 2008 and 2016. Median age at HL diagnosis was 25 years (range 15–37). After counselling on fertility preservation, 46 patients requested semen cryopreservation and 54 refused it; follow-up data was available for only 24 patients. All patients were treated with first-line chemotherapy (ABVD: adriamycin, bleomycin, vinblastine and dicarbazine), with or without radiotherapy (RT), followed by salvage chemotherapy and stem cell transplantation (HSCT) in case of refractory HL or relapse.

Pre-treatment HL patients had decreased fertility parameters compared to healthy controls, in terms of median sperm concentration and median percentages of normal-motility and normal-morphology sperms. Severe damaged sperm was observed in 17% of cases, while only 28% of patients showed normal sperm analysis. Regarding the prognostic factors, disease stages III and IV were associated with reduction in the number of spermatozoa, their motility and vitality. 54 months after completion of HL treatment, sperm motility was lower in HL patients who received HSCT, confirming that HSCT is associated with reduced spermatogenesis recovery and the most severe fertility damage.

Although this study was conducted on a small sample size of young-adult patients, it gives us interesting information about fertility status in HL, confirming the presence of specific HL-associated alterations before treatment. This could be useful not only for tailored fertility counselling, but also for improving cryopreservation technique, which have to take in account a pre-existing damage of germ cells.

References: 1. Hallak J, Mahran AM, Agarwal A. Characteristics of cryopreserved semen from men with lymphoma. J Assist Reprod Genet. 2000; 17: 591–5. 2. Rueffer U, Breuer K, Josting A, Lathan B, Sieber M, Manzke O, et al. Male gonadal dysfunction in patients with Hodgkin’s disease prior to treatment. Ann Oncol. 2001;12: 1307–11. 3. Tal R, Botchan A, Hauser R, Yogev L, Paz G, Yavetz H. Follow-up of sperm concentration and motility in patients with lymphoma. Hum Reprod. 2000;15: 1985–8