Malignant Lymphomas |
1 Department of Hematology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
2 GRECAN, EA-1772, University of Caen-Basse Normandie, Caen, France
3 Department of Gynecology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
4 Department of Hematology, Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands
5 Department of Medical Oncology, Institut Gustave Roussy, Villejuif, France
6 Department of Radiotherapy, Leiden University Medical Center, Leiden, the Netherlands
7 Department of Oncology, UZ Gasthuisberg, Leuven, Belgium
8 Department of Hematology, Institut Bergonié, Bordeaux, France
9 Department of Hematology, Hôpital Saint Louis, Paris, France
10 Department of Hematology, Centre Hospitalier Universitaire Brabois, Vandoeuvre les Nancy, France
Correspondence: Hanneke C. Kluin-Nelemans, Department of Hematology, University Medical Centre Groningen, Hanzeplein 1, 9700 RB, PO Box 30.001, Groningen, the Netherlands. E-mail: j.c.kluin{at}int.umcg.nl
Background: Although widely recommended, cryopreservation of sperm is sometimes not performed for patients with Hodgkins lymphoma because of presumed poor sperm quality related to the disease. We investigated sperm quality and factors determining it in untreated patients with early stage Hodgkins lymphoma.
Design and Methods: Of 2362 males who participated in EORTC H6–H9 trials, 474 (20%) had data available. Sperm quality was defined according to World Health Organization guidelines. Determining factors were studied by logistic regression analysis.
Results: The median sperm concentration was 40x106/mL (range, 0–345x106/mL) and the median motility 50% (range, 0–90%). Sperm quality was good (concentration
20x106/mL and motility
50%), intermediate (concentration
5x106/mL) and poor (concentration <5x106/mL but >0) in 41%, 49% and 7% of patients, respectively. Three percent of the patients were azoospermic. No relation was found between sperm quality and age or clinical stage of the Hodgkins lymphoma, but B-symptoms and elevated erythrocyte sedimentation rate predicted poor sperm quality. The odds ratios for the association of poor sperm quality with the variables examined were: presence of B-symptoms, 2.77 (95% CI, 1.50–5.12; p=0.001); erythrocyte sedimentation rate of 50 mm/h or greater, 2.35 (95% CI, 1.24–4.43; p=0.009); fever, 3.22 (95% CI, 1.41–7.33; p=0.005), and night sweats, 3.78 (95% CI, 1.97–7.26; p<0.001). There was no relation between sperm quality and pre-treatment follicle stimulating hormone level.
Conclusions: In this large study of males with Hodgkins lymphoma, 90% had good or intermediate sperm quality. Three percent were azoospermic. There was an association between sperm quality and the presence or absence of B-symptoms, in particular fever and night sweats. With modern fertilization techniques, in most patients with early-stage Hodgkins lymphoma sperm quality before treatment is good enough for future fatherhood.
Key words: Hodgkins lymphoma, fertility, male, sperm quality, sperm.