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Fertility outcomes in patients desiring conception following autologous stem cell transplantation for hodgkin lymphoma using LACE conditioning

Bone Marrow Transplantation volume 59, pages 417–418 (2024)Cite this article

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Autologous stem cell transplant (ASCT) remains the standard of care for relapsed Hodgkin lymphoma (HL). Infertility is an important long-term concern following ASCT. Preservation of fertility after ASCT can have a significant impact on the quality of life of transplant survivors. Registry studies from EBMT and CIBMTR have reported on the possibility of conception following transplant [1, 2]. Older age at transplant, use of alkylators and Total Body Irradiation (TBI) are risk factors for infertility post-transplant [3]. There are very few studies on fertility outcomes with specific non-TBI conditioning regimens. In a study that included pre-menopausal women who underwent BEAM (BCNU, etoposide, cytarabine and melphalan) conditioning and autologous transplant, 10/25 (40%) had natural conception and younger age at transplant correlated with superior fertility outcomes [4].

At our centre, we use LACE (lomustine, cytarabine, cyclophosphamide and etoposide) regimen for autologous transplants for lymphomas [5]. LACE regimen includes high dose cyclophosphamide and etoposide both of which have been reported to be associated with a high risk of gonadal failure [3]. Lomustine, a monofunctional alkylating agent is associated with high risk of infertility in female survivors of childhood cancers [6]. In this single center retrospective analysis, we analysed fertility outcomes in patients who underwent ASCT for Hodgkin’s lymphoma using LACE conditioning regimen. To our knowledge this is the first report on fertility outcomes with LACE conditioning regimen.

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Authors and Affiliations

  1. Department of Medical Oncology, Advanced Centre for Treatment, Research and Education in Cancer, Tata Memorial Centre, Homi Bhabha National Institute, Navi Mumbai, India

    Nishant Jindal, Muralidaran C, Libin Jacob Mathew, Komal Kumbhalwar, Kaumil Patel, Malini Garg, Sumeet Mirgh, Akanksha Chichra, Lingaraj Nayak, Avinash Bonda, Anant Gokarn, Sachin Punatar, Bhausaheb Bagal & Navin Khattry

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  1. Nishant Jindal
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  2. Muralidaran C
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  13. Bhausaheb Bagal
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  14. Navin Khattry
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Contributions

NJ, MC and NK designed the study, interpreted the data, and wrote the manuscript. NJ and MC performed the statistical analysis. LJB, KK, KP, MG, SM, AC, LN, AB, AN, SP BB and NK provided patient data. All the authors critically reviewed the final version of the manuscript.

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Correspondence to Navin Khattry.

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Jindal, N., C, M., Mathew, L.J. et al. Fertility outcomes in patients desiring conception following autologous stem cell transplantation for hodgkin lymphoma using LACE conditioning. Bone Marrow Transplant 59, 417–418 (2024). https://doi.org/10.1038/s41409-023-02179-x

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