| Abstract | Jedna od dugoročnih komplikacija kemoterapijskog liječenja u mladih bolesnica je gubitak
fertiliteta i funkcije jajnika što značajno utječe na njihovu kvalitetu života. Svrha ovog
istraživanja je prikazati metode očuvanja fertiliteta u žena oboljelih od limfoma i liječenih
kemoterapijom, s naglaskom na korištenje agonista hormona koji oslobađaju
gonadotropine (engl. Gonadotropin-releasing hormone agonists, GnRHa). Također, svrha
je utvrditi učinkovitost GnRH agonista u održanju cikličke ovarijske finkcije (COF) nakon
terapije. ----- Podaci iz medicinske dokumentacije žena (18-40 god.), oboljelih od limfoma u razdoblju
od 2011. do 2014. godine, izliječenih kemoterapijom, prikupljeni su i retrospektivno
analizirani. Dobiveni su podaci o vrsti limfoma i tipu kemoterapijskog protokola koji su
primale, menstrualnom statusu prije, tijekom i nakon kemoterapije, te o korištenju GnRH
agonista tijekom terapije. Na temelju toga su svrstane u GnRHa i kontrolnu grupu.
Primarni cilj bio je utvrditi postotak pacijentica s održanim COF-om nakon terapije.
Ukupno 48 bolesnica zadovoljilo je kriterije uključenja u istraživanje, a od toga je njih 8
tijekom terapije primalo GnRH agonist. Tijekom vremena praćenja (17-63 mj.), svih 8
bolesnica (100%) u GnRHa grupi povratilo je COF, dok je u kontrolnoj grupi to bio slučaj
u njih 80% (32 od 40). Razlika se nije pokazala statistički značajnom (p=0.316). S druge
strane, razlika u medijanu dobi između GnRHa i kontrolne grupe pokazala se značajnom
(p=0.047), s time da je kontrolna grupa bila starija. Osim toga, analizom je dobiveno da
nije bilo značajne razlike u uspostavi COF-a, ovisno o tome jesu li bolesnice mlađe ili
starije od 30 godina, dok su bolesnice liječene po eBEACOPP protokolu, u značajno
manjem postotku (p=0.04) uspostavile COF, u odnosu na one liječene po ABVD
protokolu. ----- Premda je 20% više bolesnica u GnRHa grupi uspostavilo COF nakon terapije, razlika se
nije pokazala značajnom, te stoga nije ustanovljena učinkovitost GnRH agonista. Ipak,
maleni broj bolesnica koje su primale GnRH agoniste mogao je utjecati na rezultat, te bi u
budućim istraživanjima trebalo uključivati više bolesnica koje bi ih primale. |
| Abstract (english) | Long term complications of chemotherapy treatment in young female patients include
loss of fertility and ovarian function, which significantly affects their life quality. The
purpose of this research was to demonstrate the methods of fertility preservation in female
patients, who suffered from lymphoma and were treated with chemotherapy, with an
emphasis on the use of gonadotropin-releasing hormone agonists (GnRHa). Furthermore,
the purpose was to assess the efficacy of GnRH agonists in restoring cyclic ovarian
function (COF) after treatment.
We collected and retrospectively analyzed data from medical records of women (18-40
years), who suffered from lymphoma in the period between 2011 and 2014, and therefore
were treated with chemotherapy. The collected data included the type of lymphoma, type
of chemotherapy regimen used, menstrual status before, during and after the
chemotherapy, and finally, whether the patient used GnRH agonist during the therapy.
Based on this, the patients were divided in the GnRHa and the control group. The primary
end point was to determine the percentage of patients who maintained COF.
Total of 48 patients met the enrollment criteria of the research, while 8 of them were
treated with GnRH agonist during the therapy. During the follow-up period (17-63
months), each of 8 patients (100%) in the GnRHa group restored COF, whilst in the
control group 80% (32/40) of patients restored it. The difference was not statistically
significant (p=0.316). On the other hand, the difference in the median age between the
GnRHa and the control group appeared to be significant (p=0.047), with the control group
being older. Furthermore, the analysis demonstrated that there was no significant
difference in restoring COF, depending on the fact that the patients were over or under 30
years old, whilst the patients treated with eBEACOPP protocol restored COF in smaller
percentage (p=0.04), compared with those treated with ABVD protocol.
In spite of the fact that 20% more patients in the GnRHa group restored COF after
therapy, the difference was not significant, therefore the efficacy of the GnRH agonist was
not proven. Still, a small number of patients receiving GnRH agonist could have affected
the results, so future research should include more patients receiving this drugs. |
