Impact of Intensified Chemoimmunotherapy Regimens in Aggressive Non‐Hodgkin Lymphoma on Reproduction Patterns
9 affiliations
- 1Division of Clinical Epidemiology, Department of Medicine Solna Karolinska Institutet Stockholm Sweden
- 2Department of Reproductive Medicine, Division of Gynecology and Reproduction Karolinska University Hospital Stockholm Sweden
- 3Red Door Analytics AB Stockholm Sweden
- 4Department of Immunology, Genetics and Pathology, Cancer Precision Medicine Uppsala University Uppsala Sweden
- 5Department of Clinical Epidemiology Aarhus University Hospital Aarhus Denmark
- 6Department of Molecular Medicine Aarhus University Hospital Aarhus Denmark
- 7Department of Hematology Aarhus University Hospital Aarhus Denmark
- 8Department of Oncology Oslo University Hospital Oslo Norway
- 9Department of Hematology Karolinska University Hospital Stockholm Sweden
Abstract
Concerns about treatment‐related fertility impairment are common among young adult lymphoma survivors. Evidence on the impact of treatment for aggressive non‐Hodgkin lymphoma (NHL) on future childbearing is limited, although many individuals of reproductive age are affected. This matched cohort study identified male (18–52 years) and female (18–40 years) patients with aggressive NHL between 2007 and 2018 in Sweden and the south‐east health‐care region in Norway, and matched lymphoma‐free comparators. Adjusted hazard ratios (aHRs) comparing childbirth rates in patients treated with primary intensive chemoimmunotherapy (CIT) (e.g., R‐CHOEP and R‐DA‐EPOCH) to standard‐of‐care (R‐CHOP), and to comparators, were estimated using Cox regression. Among 1037 young survivors of aggressive NHL, childbirth rates did not differ significantly by treatment intensity (intensive vs. standard CIT) in females (aHR: 0.61, 95% CI: 0.32–1.13) or males (aHR: 1.20, 95% CI: 0.68–2.09), overall or when stratified by time since diagnosis (< 3 and 3–10 years). However, females treated with intensive CIT had lower childbirth rates than comparators during the first 3 years after diagnosis (aHR: 0.52, 95% CI: 0.30–0.88), but not thereafter (aHR: 1.06, 95% CI: 0.57–1.96). A similar pattern was not seen in males. In Sweden, eight children (three with support from assisted reproductive techniques) were born after stem cell transplantation. In conclusion, childbirth rates did not differ by CIT intensity among survivors of aggressive NHL. Although rates were temporarily reduced in females during the treatment and recovery period after diagnosis, subsequent rates were similar to comparators. These findings provide reassurance, while highlighting the importance of early and ongoing fertility counseling.
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BibTeX
@article{antonilli2026impact,
title = {{Impact of Intensified Chemoimmunotherapy Regimens in Aggressive Non‐Hodgkin Lymphoma on Reproduction Patterns}},
author = {Stefanie Antonilli and Anna Marklund and Joshua Entrop and Caroline E. Dietrich and Ingrid Glimelius and Tarec C. El‐Galaly and Alexander Fosså and Harald Holte and Karin E. Smedby and Knut B. Smeland and Sandra Eloranta},
journal = {European Journal of Haematology},
year = {2026},
month = aug,
doi = {10.1111/ejh.70303},
url = {https://doi.org/10.1111/ejh.70303},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Impact of Intensified Chemoimmunotherapy Regimens in Aggressive Non‐Hodgkin Lymphoma on Reproduction Patterns
AU - Stefanie Antonilli
AU - Anna Marklund
AU - Joshua Entrop
AU - Caroline E. Dietrich
AU - Ingrid Glimelius
AU - Tarec C. El‐Galaly
AU - Alexander Fosså
AU - Harald Holte
AU - Karin E. Smedby
AU - Knut B. Smeland
AU - Sandra Eloranta
PY - 2026
DA - 2026/08/25
JO - European Journal of Haematology
DO - 10.1111/ejh.70303
UR - https://doi.org/10.1111/ejh.70303
AB - Concerns about treatment‐related fertility impairment are common among young adult lymphoma survivors. Evidence on the impact of treatment for aggressive non‐Hodgkin lymphoma (NHL) on future childbearing is limited, although many individuals of reproductive age are affected. This matched cohort study identified male (18–52 years) and female (18–40 years) patients with aggressive NHL between 2007 and 2018 in Sweden and the south‐east health‐care region in Norway, and matched lymphoma‐free comparators. Adjusted hazard ratios (aHRs) comparing childbirth rates in patients treated with primary intensive chemoimmunotherapy (CIT) (e.g., R‐CHOEP and R‐DA‐EPOCH) to standard‐of‐care (R‐CHOP), and to comparators, were estimated using Cox regression. Among 1037 young survivors of aggressive NHL, childbirth rates did not differ significantly by treatment intensity (intensive vs. standard CIT) in females (aHR: 0.61, 95% CI: 0.32–1.13) or males (aHR: 1.20, 95% CI: 0.68–2.09), overall or when stratified by time since diagnosis (< 3 and 3–10 years). However, females treated with intensive CIT had lower childbirth rates than comparators during the first 3 years after diagnosis (aHR: 0.52, 95% CI: 0.30–0.88), but not thereafter (aHR: 1.06, 95% CI: 0.57–1.96). A similar pattern was not seen in males. In Sweden, eight children (three with support from assisted reproductive techniques) were born after stem cell transplantation. In conclusion, childbirth rates did not differ by CIT intensity among survivors of aggressive NHL. Although rates were temporarily reduced in females during the treatment and recovery period after diagnosis, subsequent rates were similar to comparators. These findings provide reassurance, while highlighting the importance of early and ongoing fertility counseling.
SN - 0902-4441
SN - 1600-0609
ER -