GONADAL-FUNCTION FOLLOWING CHEMOTHERAPY FOR HODGKINS-DISEASE - A COMPARATIVE-STUDY OF MVPP AND A 7-DRUG HYBRID REGIMEN

Purpose and Methods: Gonadal function was assessed in 89 patients afte r chemotherapy for Hodgkin's disease (HD). Thirty-seven patients had r eceived mechlorethamine, vinblastine, prednisolone, and procarbazine ( MVPP) and 52 patients, a hybrid combination of chlorambucil, vinblasti ne, prednisolone, procarbazine, doxorubicin, vincristine, and etoposid e (ChlVPP/EVA). Fifty men (MVPP, n = 21; ChlVPP/EVA, n = 29) with a me dian age of 26 years (range, 16 to 54) and 39 women (MVPP, n = 16; Chl VPP/EVA, n = 23) with a median age of 30 years (range, 15 to 47) were studied at a median of 30 months (range, 4 to 83) following chemothera py. Results: Semen analysis showed azoospermia in 35 of 37 men, and in creased serum follicle-stimulating hormone (FSH) levels in this group confirmed severe germinal epithelial damage. Analysis of pretreatment semen in 28 men showed azoospermia in one, oligospermia in four (sperm count < 20 x 10(6)/mL), and a normal sperm count in the remaining 23. In the women, 26 of 34 (76%) with a regular menstrual cycle before co mmencing chemotherapy become amenorrheic following treatment. Menses r eturned in 10 women, who had a median age of 25 years (range, 21 to 34 ), and there were two pregnancies in this group. In the other 16, with a median age of 36 years (range, 27 to 47), amenorrhea persisted and premature ovarian failure was confirmed by increased serum gonadotroph ins and reduced estradiol (E(2)) concentrations. Of the original eight women in whom menses were maintained following treatment, two subsequ ently developed amenorrhea and the clinical and biochemical features o f an early menopause. In total, 18 of 34 women (53%) required hormone replacement therapy for chemotherapy-induced ovarian failure. Conclusi on: There was no statistically significant difference in the frequency or severity of gonadal dysfunction between MVPP- and ChlVPP/EVA-treat ed patients. We conclude that both of these chemotherapy schedules cau se substantial damage to gonadal function in both sexes.