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J Clin Oncol:两种治疗方案对晚期霍奇金淋巴瘤年轻患者性腺功能的影响PK!

2021-06-24 MedSci原创 MedSci原创

PET驱动的策略治疗的晚期霍奇金淋巴瘤患者的性腺功能障碍和不孕症的风险相比标准BEACOPPescalated方案较低

霍奇金淋巴瘤(HL)不仅是青少年和年轻成年人中最常见的癌症,也是最可治愈的癌症之一。

前瞻性、随机化的AHL2011试验显示,相比标志的6个疗程的博莱霉素、依托泊苷、阿霉素、环磷酰胺、长春新碱、丙卡嗪和泼尼松(BEACOPPescalated)方案治疗,基于正电子发射断层扫描(PET)驱动策略的早期反应的HL患者经两个疗程的BEACOPPescalated方案治疗后,再予以阿霉素、博莱霉素、长春碱和达卡巴嗪(ABVD)方案治疗,更为安全,毒性反应小。

本文报道了该治疗方案对45岁以下患者性腺功能和生育能力的益处的亚研究分析结果。

在基线、治疗结束时和5年随访过程中分别通过血清卵泡刺激素(FSH)、雌二醇和抗缪勒氏管激素来评估女性的卵巢功能,通过精液分析、FSH和睾酮水平来评估男性的睾丸功能。

两个治疗组女性患者的FSH(A)和AMH(B)水平

2011年5月19日至2014年4月29日,共招募了145位女性和424位男性患者。在PET驱动组,治疗后女性卵巢早衰(FSH>24 IU/L)和卵巢储备降低(抗缪勒氏管激素<0.5 ng/mL)的风险均降低(风险比[OR] 分别是0.20, 95%CI 0.08-0.50,p=0.001和0.15, 95%CI 0.04-0.56,p=0.005)。这两个参数都与烷基化剂的使用年龄和剂量相关。但是,在怀孕率方面没有观察到显著的差异。

两个治疗组男性患者的精子特征:A 每ml精液的精子数量;B 向前运动的精子比例

与标准BEACOPPescalated方案相比,PET驱动组的男性患者在治疗后,精子参数恢复率明显更高,睾丸严重损伤风险也更低(OR 0.26, 95%CI 0.13-0.5, p<0.0001),而且授孕率也明显更高(OR 3.7, 95%CI 1.4-9.3, p=0.004)。

总而言之,尽管两种治疗方案都会影响卵巢储备和精子发生,但PET驱动的策略治疗的晚期霍奇金淋巴瘤患者的性腺功能障碍和不孕症的风险相对较低

原始出处:

Demeestere Isabelle,Racape Judith,Dechene Julie et al. Gonadal Function Recovery in Patients With Advanced Hodgkin Lymphoma Treated With a PET-Adapted Regimen: Prospective Analysis of a Randomized Phase III Trial (AHL2011).[J] .J Clin Oncol, 2021, undefined: JCO2100068. https://doi.org/10.1200/JCO.21.00068

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    2022-02-20 minlingfeng
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    2021-06-24 anti-cancer

    谢谢梅斯分享这么多精彩信息

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