Endocrinology: Prevention of irreversible chemotherapy-induced ovarian damage in young women with lymphoma by a gonadotrophin-releasing hormone agonist in parallel to chemotherapy

To examine whether the concomitant administration of a gonadotrophin-releasinghormone agonist (GnRHa) during combination chemotherapy to youngwomen with lymphoma may facilitate preservation of gonadal function,a prospective clinical protocol was undertaken in 18 cyclingwomen with lymphoma, aged 15–40 years. Thirteen patientssuffered from Hodgkin disease (HD) and 5 from non-Hodgkin lymphoma.After informed consent a monthly injection of depot D-TRP⁶-GnRHawas administered for a maximum of 6 months starting prior tochemotherapy. Most of these patients (15/18) were treated withthe MOPP/ABV(D) combination chemotherapy followed by mantlefield irradiation in 10 patients. Hormonal profile [luteinizinghormone (LH), follicle stimulating hormone (FSH), oestradiol,testosterone, progesterone, insulin-like growth factor (IGF)-1,prolactin] was taken before the GnRHa/chemotherapy co-treatment,and monthly thereafter until resuming spontaneous ovulationand menses. This group of prospectivey treated lymphoma patientswas compared to a matched control group of 18 women (aged 17–40years) who have been treated with chemotherapy, mostly MOPP/ABV(14/18), with (11) or without (7) mantle field radiotherapy.Fourteen had Hodgkin's and four non-Hodgkin's lymphoma. Gonadalfunction was determined clinically, hormonally (LH, FSH, oestradiol,progesterone), and sono-graphically. Two of the patients ineach group died from refractory disease. Of the remaining 16patients, 15 (93.7%) resumed spontaneous ovulation and menseswithin 3–8 months of termination of the combined chemotherapy/GnRHaco-treatment. In contrast, only seven (39%) of the 18 similarlytreated patients in the control group (chemotherapy withoutGnRHa) resumed ovarian cyclic activity (regular menses). Theother 11 experienced premature ovarian failure (POF) (61%).Our preliminary data suggest a possible significant protectiveeffect of GnRHa co-treatment with chemotherapy from irreversibleovarian damage (POF).