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Several lymphoma treatments can end fertility, and the chance to preserve it exists only before the first dose. Lymphoma often strikes people in their teens, twenties and thirties, which makes this one of the few conversations that cannot be postponed.
Risk by regimen. ABVD carries a low risk and most people recover fertility. Escalated BEACOPP carries a high risk of permanent infertility in men and of premature ovarian insufficiency in women, particularly over 30; BrECADD was designed partly to reduce that risk by replacing procarbazine, and in HD21 treatment-related morbidity was 42 per cent against 59 per cent for escalated BEACOPP. R-CHOP carries a moderate risk that rises with cumulative cyclophosphamide. Conditioning for an autologous transplant (BEAM) carries a high risk. Pelvic radiotherapy and total body irradiation are gonadotoxic in their own right.
What can be done, and how fast. For men, sperm cryopreservation takes one to three samples and can usually be arranged within 48 hours; it should not delay treatment of an aggressive lymphoma by more than a few days, and a single sample is better than none. For post-pubertal women, oocyte or embryo cryopreservation needs about two weeks of ovarian stimulation, which is feasible before most first-line lymphoma treatment but not before emergency treatment of Burkitt lymphoma or a large mediastinal mass; random-start protocols have shortened it. Ovarian tissue cryopreservation is a same-week surgical option when there is no time to stimulate, and is the only option before puberty. GnRH agonists during chemotherapy may reduce the rate of premature ovarian insufficiency but are not a substitute for cryopreservation.
The practical failure is not the science but the referral: the conversation has to happen at the first oncology appointment, and a haematology unit that treats young people should have a same-week route into a reproductive medicine service. Anyone who was not offered it should ask, because in a disease with a high cure rate the decades after treatment are the point.
Showing the molecule this term concerns: Cyclophosphamide.
Shares ABVD, BEACOPP and BrECADD (Hodgkin lymphoma regimens), Procarbazine, Early-stage classical Hodgkin lymphoma (stage I to II), Relapsed and refractory classical Hodgkin lymphoma.
Shares Busulfan, Melphalan (including hepatic delivery system), Early-stage classical Hodgkin lymphoma (stage I to II), Relapsed and refractory classical Hodgkin lymphoma.
Shares Early-stage classical Hodgkin lymphoma (stage I to II), Relapsed and refractory classical Hodgkin lymphoma, Advanced-stage classical Hodgkin lymphoma (stage III to IV), Primary mediastinal (thymic) large B-cell lymphoma.
Shares GHSG HD21, Early-stage classical Hodgkin lymphoma (stage I to II), Relapsed and refractory classical Hodgkin lymphoma, Advanced-stage classical Hodgkin lymphoma (stage III to IV).
Shares Early-stage classical Hodgkin lymphoma (stage I to II), Relapsed and refractory classical Hodgkin lymphoma, Advanced-stage classical Hodgkin lymphoma (stage III to IV), Hodgkin lymphoma.
Shares Early-stage classical Hodgkin lymphoma (stage I to II), Advanced-stage classical Hodgkin lymphoma (stage III to IV), Primary mediastinal (thymic) large B-cell lymphoma, Hodgkin lymphoma.
Shares GHSG HD21, Early-stage classical Hodgkin lymphoma (stage I to II), Advanced-stage classical Hodgkin lymphoma (stage III to IV), Primary mediastinal (thymic) large B-cell lymphoma.
Shares Early-stage classical Hodgkin lymphoma (stage I to II), Relapsed and refractory classical Hodgkin lymphoma, Advanced-stage classical Hodgkin lymphoma (stage III to IV), Primary mediastinal (thymic) large B-cell lymphoma.