Risk of premature menopause after treatment for Hodgkin's lymphoma.

Anthony J Swerdlow; Rosie Cooke; Andrew Bates; David Cunningham; Stephen J Falk; Dianne Gilson; Barry W Hancock; Sarah J Harris; Alan Horwich; Peter J Hoskin; David C Linch; Andrew Lister; Helen H Lucraft; John Radford; Andrea M Stevens; Isabel Syndikus; Michael V Williams; Gabriel Anghel; Brian Attock; Jane Barrett; Andrew Bell; Kim Benstead; Eric M Bessell; Ashoke Biswas; Norbert Blesing; Caroline Brammer; Jill Brock; Alison Brownell; A Murray Brunt; Peter B Coates; Matthew P Collinson; Neville Davidson; Sian Davies; Angel Garcia; Andrew Goodman; Royal Devon; Adrian N Harnett; Timothy Illidge; Clive J R Irwin; Stephen A Kelly; Judith Kingston; Christopher Knechtli; Matthew Lyttelton; Zor Maung; Christopher McNamara; Jamey S Morgan; Philip Murray; Hugh O'Brien; Ann O'Callaghan; Nigel O'Connor; Russell Patmore; Mojca Persic; Christopher Pocock; Saad M B Rassam; Hamish Ross; Amanda Salisbury; Philip M Savage; Joanna Simpson; Roger E Taylor; Gill Thomas; Colin Trask; Nicholas West; Stephen J Whitaker

doi:10.1093/jnci/dju207

Risk of premature menopause after treatment for Hodgkin's lymphoma.

Anthony J Swerdlow, Rosie Cooke, Andrew Bates, David Cunningham, Stephen J Falk, Dianne Gilson, Barry W Hancock, Sarah J Harris, Alan Horwich, Peter J Hoskin, David C Linch, Andrew Lister, Helen H Lucraft, John Radford, Andrea M Stevens, Isabel Syndikus, Michael V Williams, Gabriel Anghel (Collaborator), Brian Attock (Collaborator), Jane Barrett (Collaborator)Andrew Bell (Collaborator), Kim Benstead (Collaborator), Eric M Bessell (Collaborator), Ashoke Biswas (Collaborator), Norbert Blesing (Collaborator), Caroline Brammer (Collaborator), Jill Brock (Collaborator), Alison Brownell (Collaborator), A Murray Brunt (Collaborator), Peter B Coates (Collaborator), Matthew P Collinson (Collaborator), Neville Davidson (Collaborator), Sian Davies (Collaborator), Angel Garcia (Collaborator), Andrew Goodman (Collaborator), Royal Devon (Collaborator), Adrian N Harnett (Collaborator), Timothy Illidge (Collaborator), Clive J R Irwin (Collaborator), Stephen A Kelly (Collaborator), Judith Kingston (Collaborator), Christopher Knechtli (Collaborator), Matthew Lyttelton (Collaborator), Zor Maung (Collaborator), Christopher McNamara (Collaborator), Jamey S Morgan (Collaborator), Philip Murray (Collaborator), Hugh O'Brien (Collaborator), Ann O'Callaghan (Collaborator), Nigel O'Connor (Collaborator), Russell Patmore (Collaborator), Mojca Persic (Collaborator), Christopher Pocock (Collaborator), Saad M B Rassam (Collaborator), Hamish Ross (Collaborator), Amanda Salisbury (Collaborator), Philip M Savage (Collaborator), Joanna Simpson (Collaborator), Roger E Taylor (Collaborator), Gill Thomas (Collaborator), Colin Trask (Collaborator), Nicholas West (Collaborator), Stephen J Whitaker (Collaborator)

Division of Cancer Sciences (L5)

Research output: Contribution to journal › Article › peer-review

Abstract

BACKGROUND: Modern treatment of Hodgkin's lymphoma (HL) has transformed its prognosis but causes late effects, including premature menopause. Cohort studies of premature menopause risks after treatment have been relatively small, and knowledge about these risks is limited. METHODS: Nonsurgical menopause risk was analyzed in 2127 women treated for HL in England and Wales at ages younger than 36 years from 1960 through 2004 and followed to 2003 through 2012. Risks were estimated using Cox regression, modified Poisson regression, and competing risks. All statistical tests were two-sided. RESULTS: During follow-up, 605 patients underwent nonsurgical menopause before age 40 years. Risk of premature menopause increased more than 20-fold after ovarian radiotherapy, alkylating chemotherapy other than dacarbazine, or BEAM (bis-chloroethylnitrosourea [BCNU], etoposide, cytarabine, melphalan) chemotherapy for stem cell transplantation, but was not statistically significantly raised after adriamycin, bleomycin, vinblastine, dacarbazine (ABVD). Menopause generally occurred sooner after ovarian radiotherapy (62.5% within five years of ≥5 Gy treatment) and BEAM (50.9% within five years) than after alkylating chemotherapy (24.2% within five years of ≥6 cycles), and after treatment at older than at younger ages. Cumulative risk of menopause by age 40 years was 81.3% after greater than or equal to 5Gy ovarian radiotherapy, 75.3% after BEAM, 49.1% after greater than or equal to 6 cycles alkylating chemotherapy, 1.4% after ABVD, and 3.0% after solely supradiaphragmatic radiotherapy. Tables of individualized risk information for patients by future period, treatment type, dose and age are provided. CONCLUSIONS: Patients treated with HL need to plan intended pregnancies using personalized information on their risk of menopause by different future time points.

Original language	English
Journal	Journal of the National Cancer Institute
Volume	106
Issue number	9
DOIs	https://doi.org/10.1093/jnci/dju207
Publication status	Published - Sept 2014

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10.1093/jnci/dju207

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Swerdlow, A. J., Cooke, R., Bates, A., Cunningham, D., Falk, S. J., Gilson, D., Hancock, B. W., Harris, S. J., Horwich, A., Hoskin, P. J., Linch, D. C., Lister, A., Lucraft, H. H., Radford, J., Stevens, A. M., Syndikus, I., Williams, M. V., Anghel, G., Attock, B., ... Whitaker, S. J. (2014). Risk of premature menopause after treatment for Hodgkin's lymphoma. Journal of the National Cancer Institute, 106(9). https://doi.org/10.1093/jnci/dju207

@article{00466586bcf94f12a7832b469a7bc017,

title = "Risk of premature menopause after treatment for Hodgkin's lymphoma.",

abstract = "BACKGROUND: Modern treatment of Hodgkin's lymphoma (HL) has transformed its prognosis but causes late effects, including premature menopause. Cohort studies of premature menopause risks after treatment have been relatively small, and knowledge about these risks is limited. METHODS: Nonsurgical menopause risk was analyzed in 2127 women treated for HL in England and Wales at ages younger than 36 years from 1960 through 2004 and followed to 2003 through 2012. Risks were estimated using Cox regression, modified Poisson regression, and competing risks. All statistical tests were two-sided. RESULTS: During follow-up, 605 patients underwent nonsurgical menopause before age 40 years. Risk of premature menopause increased more than 20-fold after ovarian radiotherapy, alkylating chemotherapy other than dacarbazine, or BEAM (bis-chloroethylnitrosourea [BCNU], etoposide, cytarabine, melphalan) chemotherapy for stem cell transplantation, but was not statistically significantly raised after adriamycin, bleomycin, vinblastine, dacarbazine (ABVD). Menopause generally occurred sooner after ovarian radiotherapy (62.5% within five years of ≥5 Gy treatment) and BEAM (50.9% within five years) than after alkylating chemotherapy (24.2% within five years of ≥6 cycles), and after treatment at older than at younger ages. Cumulative risk of menopause by age 40 years was 81.3% after greater than or equal to 5Gy ovarian radiotherapy, 75.3% after BEAM, 49.1% after greater than or equal to 6 cycles alkylating chemotherapy, 1.4% after ABVD, and 3.0% after solely supradiaphragmatic radiotherapy. Tables of individualized risk information for patients by future period, treatment type, dose and age are provided. CONCLUSIONS: Patients treated with HL need to plan intended pregnancies using personalized information on their risk of menopause by different future time points.",

author = "Swerdlow, {Anthony J} and Rosie Cooke and Andrew Bates and David Cunningham and Falk, {Stephen J} and Dianne Gilson and Hancock, {Barry W} and Harris, {Sarah J} and Alan Horwich and Hoskin, {Peter J} and Linch, {David C} and Andrew Lister and Lucraft, {Helen H} and John Radford and Stevens, {Andrea M} and Isabel Syndikus and Williams, {Michael V} and Gabriel Anghel and Brian Attock and Jane Barrett and Andrew Bell and Kim Benstead and Bessell, {Eric M} and Ashoke Biswas and Norbert Blesing and Caroline Brammer and Jill Brock and Alison Brownell and Brunt, {A Murray} and Coates, {Peter B} and Collinson, {Matthew P} and Neville Davidson and Sian Davies and Angel Garcia and Andrew Goodman and Royal Devon and Harnett, {Adrian N} and Timothy Illidge and Irwin, {Clive J R} and Kelly, {Stephen A} and Judith Kingston and Christopher Knechtli and Matthew Lyttelton and Zor Maung and Christopher McNamara and Morgan, {Jamey S} and Philip Murray and Hugh O'Brien and Ann O'Callaghan and Nigel O'Connor and Russell Patmore and Mojca Persic and Christopher Pocock and Rassam, {Saad M B} and Hamish Ross and Amanda Salisbury and Savage, {Philip M} and Joanna Simpson and Taylor, {Roger E} and Gill Thomas and Colin Trask and Nicholas West and Whitaker, {Stephen J}",

year = "2014",

month = sep,

doi = "10.1093/jnci/dju207",

language = "English",

volume = "106",

journal = "Journal of the National Cancer Institute",

issn = "0027-8874",

publisher = "Oxford University Press",

number = "9",

}

Swerdlow, AJ, Cooke, R, Bates, A, Cunningham, D, Falk, SJ, Gilson, D, Hancock, BW, Harris, SJ, Horwich, A, Hoskin, PJ, Linch, DC, Lister, A, Lucraft, HH, Radford, J, Stevens, AM, Syndikus, I, Williams, MV, Anghel, G, Attock, B, Barrett, J, Bell, A, Benstead, K, Bessell, EM, Biswas, A, Blesing, N, Brammer, C, Brock, J, Brownell, A, Brunt, AM, Coates, PB, Collinson, MP, Davidson, N, Davies, S, Garcia, A, Goodman, A, Devon, R, Harnett, AN, Illidge, T, Irwin, CJR, Kelly, SA, Kingston, J, Knechtli, C, Lyttelton, M, Maung, Z, McNamara, C, Morgan, JS, Murray, P, O'Brien, H, O'Callaghan, A, O'Connor, N, Patmore, R, Persic, M, Pocock, C, Rassam, SMB, Ross, H, Salisbury, A, Savage, PM, Simpson, J, Taylor, RE, Thomas, G, Trask, C, West, N & Whitaker, SJ 2014, 'Risk of premature menopause after treatment for Hodgkin's lymphoma.', Journal of the National Cancer Institute, vol. 106, no. 9. https://doi.org/10.1093/jnci/dju207

TY - JOUR

T1 - Risk of premature menopause after treatment for Hodgkin's lymphoma.

AU - Swerdlow, Anthony J

AU - Cooke, Rosie

AU - Bates, Andrew

AU - Cunningham, David

AU - Falk, Stephen J

AU - Gilson, Dianne

AU - Hancock, Barry W

AU - Harris, Sarah J

AU - Horwich, Alan

AU - Hoskin, Peter J

AU - Linch, David C

AU - Lister, Andrew

AU - Lucraft, Helen H

AU - Radford, John

AU - Stevens, Andrea M

AU - Syndikus, Isabel

AU - Williams, Michael V

A2 - Anghel, Gabriel

A2 - Attock, Brian

A2 - Barrett, Jane

A2 - Bell, Andrew

A2 - Benstead, Kim

A2 - Bessell, Eric M

A2 - Biswas, Ashoke

A2 - Blesing, Norbert

A2 - Brammer, Caroline

A2 - Brock, Jill

A2 - Brownell, Alison

A2 - Brunt, A Murray

A2 - Coates, Peter B

A2 - Collinson, Matthew P

A2 - Davidson, Neville

A2 - Davies, Sian

A2 - Garcia, Angel

A2 - Goodman, Andrew

A2 - Devon, Royal

A2 - Harnett, Adrian N

A2 - Illidge, Timothy

A2 - Irwin, Clive J R

A2 - Kelly, Stephen A

A2 - Kingston, Judith

A2 - Knechtli, Christopher

A2 - Lyttelton, Matthew

A2 - Maung, Zor

A2 - McNamara, Christopher

A2 - Morgan, Jamey S

A2 - Murray, Philip

A2 - O'Brien, Hugh

A2 - O'Callaghan, Ann

A2 - O'Connor, Nigel

A2 - Patmore, Russell

A2 - Persic, Mojca

A2 - Pocock, Christopher

A2 - Rassam, Saad M B

A2 - Ross, Hamish

A2 - Salisbury, Amanda

A2 - Savage, Philip M

A2 - Simpson, Joanna

A2 - Taylor, Roger E

A2 - Thomas, Gill

A2 - Trask, Colin

A2 - West, Nicholas

A2 - Whitaker, Stephen J

PY - 2014/9

Y1 - 2014/9

N2 - BACKGROUND: Modern treatment of Hodgkin's lymphoma (HL) has transformed its prognosis but causes late effects, including premature menopause. Cohort studies of premature menopause risks after treatment have been relatively small, and knowledge about these risks is limited. METHODS: Nonsurgical menopause risk was analyzed in 2127 women treated for HL in England and Wales at ages younger than 36 years from 1960 through 2004 and followed to 2003 through 2012. Risks were estimated using Cox regression, modified Poisson regression, and competing risks. All statistical tests were two-sided. RESULTS: During follow-up, 605 patients underwent nonsurgical menopause before age 40 years. Risk of premature menopause increased more than 20-fold after ovarian radiotherapy, alkylating chemotherapy other than dacarbazine, or BEAM (bis-chloroethylnitrosourea [BCNU], etoposide, cytarabine, melphalan) chemotherapy for stem cell transplantation, but was not statistically significantly raised after adriamycin, bleomycin, vinblastine, dacarbazine (ABVD). Menopause generally occurred sooner after ovarian radiotherapy (62.5% within five years of ≥5 Gy treatment) and BEAM (50.9% within five years) than after alkylating chemotherapy (24.2% within five years of ≥6 cycles), and after treatment at older than at younger ages. Cumulative risk of menopause by age 40 years was 81.3% after greater than or equal to 5Gy ovarian radiotherapy, 75.3% after BEAM, 49.1% after greater than or equal to 6 cycles alkylating chemotherapy, 1.4% after ABVD, and 3.0% after solely supradiaphragmatic radiotherapy. Tables of individualized risk information for patients by future period, treatment type, dose and age are provided. CONCLUSIONS: Patients treated with HL need to plan intended pregnancies using personalized information on their risk of menopause by different future time points.

AB - BACKGROUND: Modern treatment of Hodgkin's lymphoma (HL) has transformed its prognosis but causes late effects, including premature menopause. Cohort studies of premature menopause risks after treatment have been relatively small, and knowledge about these risks is limited. METHODS: Nonsurgical menopause risk was analyzed in 2127 women treated for HL in England and Wales at ages younger than 36 years from 1960 through 2004 and followed to 2003 through 2012. Risks were estimated using Cox regression, modified Poisson regression, and competing risks. All statistical tests were two-sided. RESULTS: During follow-up, 605 patients underwent nonsurgical menopause before age 40 years. Risk of premature menopause increased more than 20-fold after ovarian radiotherapy, alkylating chemotherapy other than dacarbazine, or BEAM (bis-chloroethylnitrosourea [BCNU], etoposide, cytarabine, melphalan) chemotherapy for stem cell transplantation, but was not statistically significantly raised after adriamycin, bleomycin, vinblastine, dacarbazine (ABVD). Menopause generally occurred sooner after ovarian radiotherapy (62.5% within five years of ≥5 Gy treatment) and BEAM (50.9% within five years) than after alkylating chemotherapy (24.2% within five years of ≥6 cycles), and after treatment at older than at younger ages. Cumulative risk of menopause by age 40 years was 81.3% after greater than or equal to 5Gy ovarian radiotherapy, 75.3% after BEAM, 49.1% after greater than or equal to 6 cycles alkylating chemotherapy, 1.4% after ABVD, and 3.0% after solely supradiaphragmatic radiotherapy. Tables of individualized risk information for patients by future period, treatment type, dose and age are provided. CONCLUSIONS: Patients treated with HL need to plan intended pregnancies using personalized information on their risk of menopause by different future time points.

U2 - 10.1093/jnci/dju207

DO - 10.1093/jnci/dju207

M3 - Article

C2 - 25139687

SN - 0027-8874

VL - 106

JO - Journal of the National Cancer Institute

JF - Journal of the National Cancer Institute

IS - 9

ER -

Risk of premature menopause after treatment for Hodgkin's lymphoma.

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