RESUMO
PURPOSE: Considering the increased cancer patient survivorship, the focus is now on addressing the impacts of treatment on quality of life. In young people, altered reproductive function is a major issue and its effects in young males are largely neglected by novel research. To improve clinician awareness, we systematically reviewed side effects of chemotherapy for Hodgkin lymphoma (HL) in young males. METHODS: The review was prospectively registered (PROSPERO N. CRD42019122868). Three databases (Medline via PUBMED, SCOPUS, and Cochrane Library) were searched for studies featuring males aged 13-51-years who underwent chemotherapy for HL using ABVD (Adriamycin® (doxorubicin), bleomycin, vinblastine, and dacarbazine) or BEACOPP (bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisolone) regimens. These chemotherapy regimens were compared against each other using sperm characteristics, FSH, and inhibin B levels to measure fertility levels. RESULTS: Data were extracted from five studies featuring 1344 patients. 6 months post-ABVD saw marked deterioration in sperm count, further reduced by more cycles (P = 0.05). Patients treated with BEACOPP rather than ABVD were more prone to oligospermia. Receiving fewer cycles of both regimens increased the likelihood of sperm production recovering. Patients treated with 6-8 cycles of BEACOPP did not recover spermiogenesis. CONCLUSIONS: ABVD and BEACOPP regimens significantly reduce fertility function to varying effects depending on treatment duration. ABVD temporarily causes significant reductions in male fertility, whereas BEACOPP's effects are more permanent. Therefore, clinicians should discuss fertility preservation with male patients receiving infertility-inducing gonadotoxic therapy. Further high-quality studies are required to more adequality describe the risk to fertility by chemotherapy.
Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Fertilidade/efeitos dos fármacos , Doença de Hodgkin/tratamento farmacológico , Infertilidade Masculina/induzido quimicamente , Protocolos de Quimioterapia Combinada Antineoplásica/farmacologia , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Bleomicina/efeitos adversos , Bleomicina/farmacologia , Bleomicina/uso terapêutico , Ciclofosfamida/efeitos adversos , Ciclofosfamida/farmacologia , Ciclofosfamida/uso terapêutico , Dacarbazina/efeitos adversos , Dacarbazina/farmacologia , Dacarbazina/uso terapêutico , Doxorrubicina/efeitos adversos , Doxorrubicina/farmacologia , Doxorrubicina/uso terapêutico , Etoposídeo/efeitos adversos , Etoposídeo/farmacologia , Etoposídeo/uso terapêutico , Humanos , Masculino , Prednisona/efeitos adversos , Prednisona/farmacologia , Prednisona/uso terapêutico , Procarbazina/efeitos adversos , Procarbazina/farmacologia , Procarbazina/uso terapêutico , Vimblastina/efeitos adversos , Vimblastina/farmacologia , Vimblastina/uso terapêutico , Vincristina/efeitos adversos , Vincristina/farmacologia , Vincristina/uso terapêuticoAssuntos
Proteínas de Ligação a DNA/genética , Linfoma Folicular/genética , Mutação/genética , Recidiva Local de Neoplasia/genética , Fatores de Transcrição/genética , Adulto , Idoso , Idoso de 80 Anos ou mais , Western Blotting , Estudos de Coortes , Metilação de DNA , Proteína Potenciadora do Homólogo 2 de Zeste , Epigênese Genética , Feminino , Histonas , Humanos , Técnicas Imunoenzimáticas , Linfoma Folicular/diagnóstico , Linfoma Folicular/metabolismo , Lisina , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/diagnóstico , Recidiva Local de Neoplasia/metabolismo , Complexo Repressor Polycomb 2 , Prognóstico , RNA Mensageiro/genética , Reação em Cadeia da Polimerase Via Transcriptase Reversa , Taxa de Sobrevida , Análise Serial de Tecidos , Adulto JovemRESUMO
BACKGROUND: The addition of rituximab to combination chemotherapy with cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP), or R-CHOP, has significantly improved the survival of patients with diffuse large-B-cell lymphoma. Whether gene-expression signatures correlate with survival after treatment of diffuse large-B-cell lymphoma is unclear. METHODS: We profiled gene expression in pretreatment biopsy specimens from 181 patients with diffuse large-B-cell lymphoma who received CHOP and 233 patients with this disease who received R-CHOP. A multivariate gene-expression-based survival-predictor model derived from a training group was tested in a validation group. RESULTS: A multivariate model created from three gene-expression signatures--termed "germinal-center B-cell," "stromal-1," and "stromal-2"--predicted survival both in patients who received CHOP and patients who received R-CHOP. The prognostically favorable stromal-1 signature reflected extracellular-matrix deposition and histiocytic infiltration. By contrast, the prognostically unfavorable stromal-2 signature reflected tumor blood-vessel density. CONCLUSIONS: Survival after treatment of diffuse large-B-cell lymphoma is influenced by differences in immune cells, fibrosis, and angiogenesis in the tumor microenvironment.