Fertility Counseling and Preservation in Patients With NHL

Researchers at ASH 2024 explained that adolescents and young adults with non-Hodgkin lymphoma (NHL) face potential fertility challenges due to treatment. However, barriers such as time constraints and financial limitations complicate fertility counseling and preservation. This study analyzed data from the Lymphoma Epidemiology of Outcomes cohort, focusing on fertility discussions and preservation among patients with NHL aged 18–50 years.

From 2015–2020, 77 patients completed fertility-related follow-up surveys three years post-diagnosis. The cohort included 46% females and 53% males, with a median diagnosis age of 40 years. Of these, 36 participants (47%) were aged 18–39. Most were non-Hispanic White (69%), while others identified as Hispanic (22%), Black (4%), or Asian (3%). Treatments included alkylators (78%), non-alkylators (15.6%), and radiation (6.5%), with 71% having aggressive lymphomas.

Fertility preservation was reported in 6% of females and 12.2% of males, exclusively in the younger age group (18–39). Fertility discussions were more common among females (72%) than males (59%), although this was not statistically significant. Younger patients (18–39 years) were significantly more likely to have fertility discussions than older patients (OR 10.2, P<.001), as were those treated with alkylators (OR 9.0, P<.01). Patients with aggressive lymphoma also had more discussions compared to those with indolent types (OR 4.2, P=.01). Notably, Hispanic, Black, and Asian patients were more likely to discuss fertility than non-Hispanic White patients (OR 0.2, P<.01).

In multivariable analysis, younger age (OR 10.9) and alkylator use (OR 8.9) remained significant predictors of fertility discussions, with White race trending towards less frequent discussions. According to the authors, there is a critical need to integrate fertility counseling for all childbearing-age cancer patients to ensure informed decisions and equitable care.

Reference:

Toumeh N, Larson MC, Negaard BJ, et al. Occurrence and predictors of patient reported fertility discussions in non-Hodgkin lymphoma patients: Utilizing the lymphoma epidemiology of outcomes (leo) cohort study. Abstract 3736. Presented at ASH 2024. San Diego, California.