O-227 Pre-treatment semen parameters in haematological malignancies. An analysis of sequential samples
Authors: Lukaszewski T , Williamson E , Sangster P , Yasmin E 
Published: August 2021

Abstract

Study question
Does Leukaemia affect spermatogenesis more adversely than Hodgkin’s lymphoma and is the effect consistent in sequential samples?

Summary answer
LLeukaemia is associated with a higher incidence of azoospermia, oligozoospermia and asthenozoospermia compared to Hodgkin’s lymphoma. These findings were consistent in sequential samples.

What is known already
Hodgkin’s lymphoma (HL) and leukaemias are common haematological malignancies that affect young men. Although not all treatments for these malignancies are gonadotoxic, there is evidence that malignancy affects sperm quality. Our own analysis in over 3000 men revealed that a diverse group of malignancies affected semen parameters adversely. There is concern that a single sample analysis may not reveal the true state due to varied period of abstinence and naturally occurring variation in semen quality. Leukaemia and lymphoma are systemic diseases; leukaemia usually runs a more torrid course whilst HL a more indolent course and therefore may variably affect spermatogenesis.

Study design, size, duration
A retrospective analysis was performed on 125 men with leukaemia and 303 men with HL. Only those men who had sequential semen analyses (1 and 2) within a month were included. Volume, sperm concentration and motility were the selected parameters in samples 1 and 2. Time period was April 1980 to January 2021.

Participants/materials, setting, methods
We included all post-pubertal men diagnosed with 2 most common haematological malignancies (Hodgkin’s lymphoma and leukaemia) in our database. Patient’s demographics, cancer diagnosis and semen parameters were extracted from a secure electronic database and analysed using MS Excel. Cancer diagnoses were obtained from referral letters from oncologists. Differences between samples 1 and 2 were tested using Fisher’s test, and odds ratios (OR) were calculated for the two malignancy groups.

Main results and the role of chance
We analysed 250 samples in 125 men with leukaemia and 606 samples in 303 men with HL. The mean intervals between the two semen samples were similar; 4.4 (1-30) and 3.8 (1-30) days. There were 95.7% of men &lt;40 years in the HL group and 90.4% in the leukaemia group. There was no significant difference in the incidence of low volume (&lt;1.5ml), sperm concentration or motility between samples 1 and 2 in both groups. Oligospermia was more frequently associated with leukaemia (OR 2.22, CI 95%, 1.44-3.43). Although the incidence of severe oligozoospermia was similar between the two cancer groups (OR 0.99, 95% CI 0.55 - 1.99), azoospermia was observed to have a greater association with leukaemia than HL (OR 3.22, 95% CI 1.57-6.63). There was also a greater association of asthenozoospermia with leukaemia compared to HL (OR 2.76, 95% CI 1.76-4.35). As there was consistency between samples 1 and 2 in both groups, odds ratio calculation for sample 2 revealed similar results as for sample 1.

Limitations, reasons for caution
As we selected men with at least two semen samples on two separate occasions, we had to exclude men with single samples which substantially reduced the number of participants. Types of leukaemia and the stage of disease in HL were not analysed.

Wider implications of the findings
Our findings are pertinent when counselling men about fertility preservation even in the absence of planned gonadotoxic treatment. Awareness about increased azoospermia incidence may help plan oncoTESE procedures. Our findings could form a basis for studies examining spermatogenesis pathways in haematological malignancies.

Trial registration number
not applicable