Fertility after chemotherapy for Hodgkin lymphoma

The RATHL Trial and the need to establish the impact of different chemotherapies on fertility.

Text that says Results

Chemotherapy can damage ovaries, which can cause early menopause and infertility, but this doesn’t happen to everyone. Many people affected by Hodgkin lymphoma are younger and might be concerned about their future fertility after treatment. There is an urgent need to establish the impact of different chemotherapies on fertility so that people with Hodgkin lymphoma can consider options for preserving their fertility.

The RATHL (Response-Adapted Therapy for Hodgkin Lymphoma) clinical trial was a large trial that aimed to find out if PET scans could be used to guide treatment decisions in Hodgkin lymphoma.  

In the RATHL trial, a PET scan given after 2 cycles of standard ABVD chemotherapy was used to decide what further treatment people needed. People with a good response (PET negative) were randomised either to continue ABVD or to receive AVD with bleomycin (B) being omitted. People who didn't respond well (PET positive) were given more intensive chemotherapy - BEACOPP.

The trial showed that many people could be spared some side effects of chemotherapy by being treated with less intensive chemotherapy if they had a good initial response.

Women between 18 and 45 years old who took part in RATHL were asked to participate in a study to find out what effect their treatment had on their fertility. The results of this study were reported in Lancet Oncology in September 2018. The study measured levels of hormones produced by the ovaries. Levels were measured before and during treatment, and once a year after treatment for 3 years to see how well the ovaries recovered. All of the chemotherapy regimens used caused changes in hormone levels during treatment, but recovery after treatment depended on what chemotherapy was given and age.

Women under 35 who had ABVD or AVD chemotherapy had complete recovery of hormone levels one year after treatment.

Women over 35 who had ABVD or AVD chemotherapy had a slower or less complete recovery of hormone levels, even if their hormone levels were normal before treatment.

Women treated with BEACOPP were much more likely to have irreversible changes in hormone levels, and an early menopause. Five of the seven participants treated with BEACOPP had not seen any recovery in hormone levels 3 years after treatment.

Prof Richard Anderson, MRC Centre for Reproductive Health, Queens Medical Research Institute, University of Edinburgh and Prof Peter Johnson, Cancer Research UK Centre, University of Southampton worked on this study. They said:

‘The lack of detectable damage to the ovaries after treatment with ABVD or AVD in younger women with Hodgkin lymphoma is reassuring, but the finding of damage to the ovaries in women over 35, or those having more intensive BEACOPP chemotherapy, means that ways of preserving their ability to have children should be discussed before starting treatment, if possible.’

Studies like these are only possible because people agree to take part to help drive forward improvements in treatment and care for people with lymphoma. Find out more about clinical trials and research studies at Lymphoma TrialsLink, and search our database to see if there is a study suitable for you.