Pregnancy Disproved as Potential Trigger for Relapse in Hodgkin Lymphoma Survivors

Pregnancy Disproved Trigger for Relapse Hodgkin Lymphoma

Caroline Weibull, MSc

Swedish researchers have discovered that becoming pregnant while experiencing remission of Hodgkin lymphoma does not increase the risk of relapse. Their report is currently the largest study that specifically examines the impacts of pregnancy as a potential trigger for relapse in Hodgkin lymphoma survivors.

The study¹, published in theJournal of Clinical Oncology, compiled data from 449 women, aged 18-40, from Swedish health care registries and medical records. The women studied in the case were diagnosed with Hodgkin lymphoma between 1992 and 2009. Their data was examined by researchers starting 6 months after their diagnosis.

The team of researchers defined a pregnancy-related relapse as one happening either during pregnancy or within 5 years of giving birth.

Of the 449 women examined in the study, 144 women became pregnant during the examination period, with 1 of those patients experiencing a relapse within the 5-year time frame. In the group of patient participants who did not become pregnant or give birth during the study’s time period, 49 people experienced a relapse.

Researchers were able to conclude that women who became pregnant had a lower rate of relapse than women who did not, though they warned this difference was not statistically significant.

“Based on these findings, we see no evidence that Hodgkin lymphoma survivors who become pregnant are at higher risk for relapse,” said lead study author Caroline Weibull, MSc, a biostatistician and doctoral student, Department of Medical Epidemiology and Biostatistics, Karolinska Institutet in Stockholm, Sweden, in a statement.²

According to co-author Ingrid Glimelius, MD, PhD, oncologist, Akademiska Hospital in Uppsala, Sweden and researcher affiliated with Uppsala University’s Department of Immunology, performing this study was important for many Hodgkin lymphoma survivors who are at the childbearing age.

“We conducted this study because Hodgkin lymphoma survivors, as well as clinicians, have expressed worries that pregnancy may increase the risk of relapse, despite a lack of empirical evidence to support such concerns,” said Dr Glimelius said in a statement.²“This rigorous study should help put those fears to rest.”

Hodgkin lymphoma is a type of cancer that is most commonly found in adolescents and young adults. The disease has demonstrated a relatively high survival rate, especially in women below the age of 45.²It most commonly affects lymph nodes in the neck, the area between the lungs or the back of the breastbone, and has been known to spread to the spleen, liver, bone marrow or bone.³

The American Cancer Society predicted that Hodgkin’s lymphoma would affect an estimated 9,050 people this year in the United States, of which 1,150 people are expected to die from the disease.³

With its relatively high survival rate, researchers suggested that a certain selection-bias, known as the “healthy mother effect,” may be an influencing factor in the lack of relapses among women who gave birth during their remission time.²The effect asserts that women with less severe disease are more likely to become pregnant while also more likely to have a lower risk of relapse, though Weibull explained that this might not entirely be the case.

“We saw no evidence of a ‘healthy mother effect’ in our study,” said Weibull in a statement.²“After accounting for differences in age and disease severity, we found that the probability of becoming pregnant did not differ markedly between patients with advanced and early stage disease or between patients who had different types of chemotherapy.”

Merry-Jennifer Markham, MD, ASCO expert in lymphoma, added that the study’s results are promising for many women diagnosed with the disease.

“This is welcome and reassuring news for women who are in remission from Hodgkin lymphoma and wish to become pregnant,” said Dr Markham in a statement.²“This study is also a reminder that fertility after cancer remains an important concern for many patients, and it’s a topic that should be discussed more frequently between physicians and their patients.”

References

1. Weibull C, Eloranta S, Smedby K et al. Pregnancy and the Risk of Relapse in Patients Diagnosed With Hodgkin Lymphoma. Journal of Clinical Oncology. 2015. doi:10.1200/jco.2015.63.3446.
2. ASCO.org. Pregnancy Does Not Increase Risk of Hodgkin Lymphoma Relapse. 2015. Available at: http://www.asco.org/press-center/pregnancy-does-not-increase-risk-hodgkin-lymphoma-relapse. Accessed December 16, 2015.
3. Cancer.Net. Lymphoma - Hodgkin - Overview. 2012. Available at: http://www.cancer.net/cancer-types/lymphoma-hodgkin/overview. Accessed December 16, 2015.