Choice Of Cytotoxic Regimens

Currently, treatment regimens for hematologic malignancy include a variety of chemotherapeutic agents, all of which affect reproductive functions differently. For young patients, agents with minimal toxicity but maximal therapeutic effect are selected. For example, NOVP (Novantrone (mitoxantrone), Oncovin (vincristine), Vinblastine, Prednisone) may be preferred over MOPP (nitrogen mustard, vincristine, procarbazine, and pred-nisone) for the treatment of Hodgkin's lymphoma. Although NOVP markedly affects spermatogenesis, sperm production recovers rapidly after treatment, usually within 3 to 4 months. This rapid recovery is due to the fact that NOVP chemotherapy damages spermato-genic germ cells rather than inhibiting stem cells.61

Similarly, ABVD (adriamycin, bleomycin, vinblas-tine, and dacarbazine) is used to treat Hodgkin's disease instead of MOPP because the former dramatically reduces gonadal toxicity.62 VAPEC-B (adri-amycin, cyclophosphamide, etoposide, vincristine, bleomycin, and prednisolone), which is used in the treatment of non-Hodgkin's lymphoma, minimizes the dose of cyclophosphamide and therefore results in less gonadal failure than CHOP-Bleo (cyclophos-phamide, adriamycin, Oncovin (vincristine), pred-nisone, bleomycin).63

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