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J Clin Oncol. 2016 Feb 1;34(4):337-44. doi: 10.1200/JCO.2015.63.3446. Epub 2015 Dec 14.

Pregnancy and the Risk of Relapse in Patients Diagnosed With Hodgkin Lymphoma.

Author information

1
Caroline E. Weibull, Sandra Eloranta, Karin E. Smedby, Anna L.V. Johansson, Paul W. Dickman, and Ingrid Glimelius, Karolinska Institutet; Karin E. Smedby, Magnus Björkholm, Sigurdur Y. Kristinsson, and Ingrid Glimelius, Karolinska University Hospital Solna, Stockholm; Ingrid Glimelius, Uppsala University, Uppsala, Sweden; and Sigurdur Y. Kristinsson, University of Iceland, Reykjavik, Iceland. caroline.weibull@ki.se.
2
Caroline E. Weibull, Sandra Eloranta, Karin E. Smedby, Anna L.V. Johansson, Paul W. Dickman, and Ingrid Glimelius, Karolinska Institutet; Karin E. Smedby, Magnus Björkholm, Sigurdur Y. Kristinsson, and Ingrid Glimelius, Karolinska University Hospital Solna, Stockholm; Ingrid Glimelius, Uppsala University, Uppsala, Sweden; and Sigurdur Y. Kristinsson, University of Iceland, Reykjavik, Iceland.

Abstract

PURPOSE:

Many patients and clinicians are worried that pregnancy after the diagnosis of Hodgkin lymphoma (HL) may increase the risk of relapse despite a lack of empirical evidence to support such concerns. We investigated if an association exists between pregnancy and relapse in women with a diagnosis of HL.

MATERIALS AND METHODS:

Using Swedish healthcare registers combined with medical records, we included 449 women who received a diagnosis of HL between 1992 and 2009 and who were age 18 to 40 years at diagnosis. Follow-up started 6 months after diagnosis, when the patients' condition was assumed to be in remission. Pregnancy-associated relapse was defined as a relapse during pregnancy or within 5 years after delivery. Hazard ratios (HRs) with 95% CIs were estimated by using the Cox proportional hazards model.

RESULTS:

Among the 449 women, 144 (32%) became pregnant during follow-up. Overall, 47 relapses were recorded, of which one was a pregnancy-associated relapse. The adjusted HR for the comparison of the pregnancy-associated relapse rate to the non-pregnancy-associated relapse rate was 0.29 (95% CI, 0.04 to 2.18). The expected number of relapses in women with a recent pregnancy, given that they would experience the same relapse rate as that of women without a recent pregnancy, was 3.76; the observed-to-expected ratio was 0.27 (95% exact CI, 0.01 to 1.51).

CONCLUSION:

We found no evidence that a pregnancy after diagnosis increases the relapse rate among women whose HL is in remission. Survivors of HL need to consider a range of factors when deciding about future reproduction. However, given the results of this study, the risk of pregnancy-associated relapse does not need to be considered.

PMID:
26668344
DOI:
10.1200/JCO.2015.63.3446
[Indexed for MEDLINE]

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