The Impact of Chemotherapy on Gonadal Function in Female Patients with Hodgkin and Non-Hodgkin Lymphoma: A Comprehensive Analysis of Hormonal Kinetics and Implications for Fertility and Contraceptive Planning

Abstract

Simple Summary Young women with Hodgkin lymphoma (HL) and primary mediastinal B-cell lymphoma (PMBCL) have excellent survival rates, making preservation of reproductive function an important aspect of long-term care. However, prospective data on chemotherapy-induced ovarian damage have remained limited. In this prospective study, ovarian function was serially evaluated before, during, and after chemotherapy using established hormonal markers. Anti-Müllerian hormone (AΜH) emerges as the most sensitive and reliable marker of gonadal function, with a threshold of 7 pmol/L being predictive of impaired ovarian reserve in HL patients. Women with HL demonstrated evidence of reduced ovarian reserve prior to treatment, and pretreatment AMH concentrations identified patients at increased risk of persistent ovarian insufficiency following chemotherapy. In contrast, patients with PMBCL treated with dose-adjusted EPOCH-R experienced more sustained ovarian impairment, and no pretreatment biomarker reliably predicted ovarian recovery. These findings characterize treatment-related changes in ovarian reserve and may support individualized pretreatment reproductive counseling in young women receiving chemotherapy for lymphoma.