How does ABVD chemotherapy affect the fertility of female patients with Hodgkin lymphoma?

This study examined if ABVD chemotherapy impacted fertility in female patients with Hodgkin lymphoma (HL). The authors found that ABVD reduced the levels of one of the fertility hormones and the type of fertility treatment patients opted for was not affected by ABVD.

Many patients with HL are young and fertility may be a short- or long-term concern. ABVD (adriamycin, bleomycin, vinblastine, and dacarbazine) is the main type of chemotherapy used to treat young patients with HL. ABVD is not known to affect fertility. However, its influence on the number of eggs in female patients has not been directly studied. 

Data from 105 female patients with HL that received fertility treatment before ABVD treatment was examined. For the fertility treatment, 38 patients had their eggs frozen and 44 patients had their ovary tissue frozen. Patients’ data were available for an average of 33.2 months.

Anti-Müllerian hormone (AMH) is a fertility hormone involved in preparing eggs for release from the ovaries. It is associated with the number of eggs a woman has left (ovarian reserve). Patients’ AMH levels dropped from 2.2 ng/mL before ABVD treatment to 1.22 ng/mL after 33.2 months. This decrease in women in the general population.

15 patients required further treatment with stem cell transplantation. In patients who received a stem cell transplant, AMH levels dropped to 0.14 ng/mL. The number of eggs being prepared for each menstrual cycle dropped from 18 to 10.

The type of fertility treatment made no difference to AMH levels or egg numbers.

The authors concluded that ABVD reduced the levels of AMH and the number of eggs available in female patients but did not affect the choice of fertility treatment. The authors also suggested that young women with HL should be counseled to have fertility preservation before beginning treatment.

This study used medical records data meaning that not all information was available for patients such as the dose of ABVD. The authors used AMH levels from the US population which may not reflect AMH levels in other countries. No data was available on patients’ fertility following treatment, such as how many patients became pregnant.