Synchronous hodgkin lymphoma in monozygotic twins: a case report of ovarian stimulation with aromatase inhibitors and recombinant follicle-stimulating hormone

Vollständiger Abstract

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Hodgkin lymphoma (HL) is one of the most common malignancies affecting young adults of reproductive age. Given the high long-term survival rates, fertility preservation has become a critical aspect of comprehensive patient care. Alkylating agents (procarbazine, cyclophosphamide), which are included in standard chemotherapy regimens, exhibit the highest gonadotoxic potential. However, cases of synchronous HL in monozygotic twins followed by controlled ovarian stimulation are extremely rare in the literature.Aim. To present a clinical case of successful controlled ovarian stimulation using Aromatase inhibitors and recombinant follicle-stimulating hormone (rFSH) with subsequent oocyte cryopreservation in two patients with synchronous classical HL prior to the initiation of antitumor therapy.The study included two monozygotic female twins born in 2000 with newly diagnosed classical HL. The first patient was diagnosed with stage IIA disease (international prognostic index 0.4), the second with stage IVB (international prognostic index 1). Both patients underwent controlled ovarian stimulation using a protocol with Aromatase inhibitors and rFSH, followed by transvaginal oocyte retrieval and vitrification of mature oocytes prior to chemotherapy. After completion of the fertility preservation procedures, the patients received polychemotherapy according to the ABVD regimen (6 cycles) and BEACOPP-14 (8 cycles), respectively. Treatment response was assessed by positron emission tomography / computed tomography.A total of 7 and 5 mature oocytes were successfully retrieved and cryopreserved in the first and second patient, respectively. Both procedures were well tolerated, with no adverse events requiring protocol modification or discontinuation. Following completion of chemotherapy, both patients achieved complete metabolic response on positron emission tomography / computed tomography.This case report demonstrates that controlled ovarian stimulation with Aromatase inhibitors and rFSH followed by oocyte cryopreservation is a feasible and effective fertility preservation strategy in patients with synchronous HL, including those with advanced-stage disease requiring intensive chemotherapy regimens. This observation underscores the critical importance of early multidisciplinary collaboration between oncologists and reproductive medicine specialists to ensure timely fertility preservation in young patients.