Preserving fertility in young patients with lymphoma: an overview

Figures & data

Table 1 Effect of cell-cycle-specific and -nonspecific agents on ovarian function

Drug Type	G1	S	G2	M
Cell-cycle-specific agents
Drug	L-Asparaginase	Cytarabine	Bleomycin	vinblastine
	Prednisone	5-Fluorouracil	Etoposide	vincristine
		Hydroxyurea		Paclitaxel
		Methotrexate
		Thioguanine
Ovarian damage	No/low risk	No/low risk	No/low risk	No/low risk
Drug type	Alkylators	Antitumor antibiotics	Nitrosoureas	Miscellaneous
Cell-cycle-nonspecific agents
Drug	Cyclophosphamide	Dactinomycin	Carmustine	Dacarbazine
	Ifosfamide	Daunorubicin	Lomustine	Procarbazine
	Carboplatin	Doxorubicin	Streptozotocin
	Cisplatin	Mitomycin
	Busulfan	Mitoxantrone
		Chlorambucil
		Mechlorethamine
		Melphalan
Ovarian damage	High	Intermediate	Intermediate	High

Note: Data from Devita et al.¹⁹

Table 2 Effect of radiotherapy on ovarian function

Ovarian	Risk of ovarian failure
dose (cGy)	Women aged 15-40 years	Women >40 years
<60	No adverse effects	No adverse effects
150	Minimal adverse effects in young women	Some risk of sterilization in women over 40 years
250–500	60% sterilized; remainder may experience transient amenorrhea	100% sterilized
500–800	60%–70% sterilized; remainder may experience transient amenorrhea	100% sterilized
>800	100% sterilized	100% sterilized

Note: Data from Damewood and Grochow.³⁴

Table 3 2012 National in vitro fertilization live-birth rates per embryo transfer

	Age (years)
	Oocyte donor	<35	35-37	38-40	41-42	>42
Fresh-cycle live birth per ET (%)	56.6	47.1	37.9	28.5	16.3	6.1
Cryopreserved/thawed-cycle live birth per ET (%)	37.2	42.4	39.8	33.9	26.4	17.8
Average number of embryos transferred	1.8	1.8	1.8	1.8	1.9	2.0

Note: Data from Society for Assisted Reproductive Technology.⁶⁶

Table 4 Effects of chemotherapeutic agents on male fertility

Chemotherapy (dose-to-cause effect)	Adverse effect on sperm count
Chlorambucil (1.4 g/m^2)	Prolonged or permanent azoospermia
Cyclophosphamide (19 g/m^2)
Procarbazine (4 g/m^2)
Melphalan (140 mg/m^2)
Cisplatin (500 mg/m^2)
BCNU (1 g/m^2)	Azoospermia in adulthood if treated before puberty
CCNU (500 mg/m^2)
Busulfan (600 mg/m^2)	Azoospermia likely, and are often given with other highly sterilizing agents, adding to the effect
Ifosfamide (42 g/m^2)
BCNU (300 mg/m^2)
Nitrogen mustard
Actinomycin D
Doxorubicin (770 mg/m^2)	When used alone, cause only temporary reduction in sperm count; in conjunction with above agents, may be additive in causing azoospermia
Thiotepa (400 mg/m^2)
Cytarabine (1 g/m^2)
vinblastine (50 g/m^2)
vincristine (8 g/m^2)
Amsacrine	When used in conventional regimens, cause only temporary reductions in sperm count; in conjunction with above agents, may be additive in causing azoospermia
Bleomycin
Dacarbazine
Daunorubicin
Epirubicin
Etoposide
Fludarabine
Fluorouracil
6-Mercaptopurine
Methotrexate
Mitoxantrone
Thioguanine

Note: Data from Devita et al.¹⁹

Abbreviations: BCNU, bis-chloroethylnitrosourea (carmustine); CCNU, 1-(2-chloroethyl)-3-cyclohexyl-1-nitrosourea (lomustine).

DeVita VT, Hellmann S, Rosenberg SA, editors. Cancer: Principles and Practice of Oncology. 7th ed. Philadelphia: Lippincott Williams & Wilkins; 2005.

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Damewood MD, Grochow LB. Prospects for fertility after chemotherapy or radiation for neoplastic disease. Fertil Steril. 1986;45(4):443–459.

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Society for Assisted Reproductive Technology. Clinic summary report. 2012. Available from: https://www.sartcorsonline.com/rptCSR_PublicMultYear.aspx?ClinicPKID=0. Accessed May 15, 2014.

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