Hodgson David C, Pintilie Melania, Gitterman Leah, Dewitt Beth, Buckley Carol-Ann, Ahmed Sameera, Smith Katherine, Schwartz Amanda, Tsang Richard W, Crump Michael, Wells Woodrow, Sun Alexander, Gospodarowicz Mary K
Department of Radiation Oncology, Princess Margaret Hospital, University Health Network, Toronto, Canada.
Hematol Oncol. 2007 Mar;25(1):11-5. doi: 10.1002/hon.802.
Although ABVD (doxorubicin, bleomycin, vinblastine, dacarbazine) chemotherapy is infrequently associated with premature amenorrhea, little is known about the success rate of women attempting pregnancy following ABVD. In the present study females treated for HL with ABVD chemotherapy without pelvic radiation therapy (RT) and who were alive without relapse > or =3 years after treatment were identified from a clinical database and screened for inclusion. Using a standardized questionnaire, we determined the pregnancy rate (i.e. time-to-pregnancy, TTP) among survivors who had become pregnant, tried to become pregnant, or who had been sexually active for over 2 months without using contraception at any time following ABVD. The cumulative incidence of pregnancy was calculated using the Kaplan-Meier method. Cox proportional hazards models were constructed to compare the pregnancy rate among HL survivors to that reported by friend or sibling controls. Thirty-six female HL survivors, who had attempted pregnancy after ABVD treatment, and 29 controls, completed the survey. Eighteen patients (50%) received 2-4 cycles of ABVD, 16 (44%) received 4-6 cycles, and 2 (6%) received >6 cycles. The median TTP among both HL survivors and controls was 2.0 months. The 12-month pregnancy rates were 70% and 75%, respectively. The fertility ratio (FR) for HL survivors versus controls was 0.94 (95%CI = 0.53-1.66; p = 0.84) after adjusting for age and frequency of intercourse (where FR < 1 indicates subfertility). Age at treatment and the number of cycles of chemotherapy were not associated with pregnancy rate among HL survivors. Female HL patients who had survived without recurrence > or =3 years and who had attempted pregnancy after ABVD did not experience significant sub-fertility.
尽管阿霉素、博来霉素、长春花碱、达卡巴嗪（ABVD）化疗很少导致过早闭经，但对于接受ABVD化疗后尝试怀孕的女性的成功率却知之甚少。在本研究中，从临床数据库中识别出接受ABVD化疗治疗霍奇金淋巴瘤（HL）且未接受盆腔放射治疗（RT）、治疗后存活且无复发≥3年的女性，并进行纳入筛查。使用标准化问卷，我们确定了在接受ABVD治疗后怀孕、尝试怀孕或在任何时间未采取避孕措施且性活跃超过2个月的幸存者中的怀孕率（即怀孕时间，TTP）。使用Kaplan-Meier方法计算怀孕的累积发生率。构建Cox比例风险模型，以比较HL幸存者与朋友或兄弟姐妹对照组报告的怀孕率。36名接受ABVD治疗后尝试怀孕的女性HL幸存者和29名对照组完成了调查。18名患者（50%）接受了2-4个周期的ABVD治疗，16名（44%）接受了4-6个周期，2名（6%）接受了>6个周期。HL幸存者和对照组的中位TTP均为2.0个月。12个月的怀孕率分别为70%和75%。在调整年龄和性交频率后，HL幸存者与对照组的生育力比值（FR）为0.94（95%CI = 0.53-1.66；p = 0.84）（其中FR < 1表示生育力低下）。治疗时的年龄和化疗周期数与HL幸存者的怀孕率无关。在接受ABVD治疗后存活且无复发≥3年并尝试怀孕的女性HL患者中，未出现明显的生育力低下。
