PURPOSE: The purpose of this study is to evaluate the use of fertility-preserving (FP) treatments and fertility counseling that was offered in a cohort of newly diagnosed children with classical Hodgkin lymphoma (cHL). METHODS: In this observational study, boys and girls with cHL aged ≤ 18 years with scheduled treatment according to the EuroNet-PHL-C2 protocol were recruited from 18 sites (5 countries), between January 2017 and September 2021. In 2023, a subset of Dutch participants (aged ≥ 12 years at time of diagnosis) and parents/guardians were surveyed regarding fertility counseling. RESULTS: A total of 101 boys and 104 girls were included. Most post-pubertal boys opted for semen cryopreservation pre-treatment (85% of expected). Invasive FP treatments were occasionally chosen for patients at a relatively low risk of fertility based on scheduled alkylating agent exposure (4/5 testicular biopsy, 4/4 oocyte, and 11/11 ovarian tissue cryopreservation). A total of 17 post-menarchal girls (20%) received GnRH-analogue co-treatment. Furthermore, 33/84 parents and 26/63 patients responded to the questionnaire. Most reported receiving fertility counseling (97%/89%). Statements regarding the timing and content of counseling were generally positive. Parents and patients considered fertility counseling important (94%/87% (strongly agreed) and most expressed concerns about (their child's) fertility (at diagnosis 69%/46%, at present: 59%/42%). CONCLUSION: Systematic fertility counseling is crucial for all pediatric cHL patients and their families. FP treatment should be considered depending on the anticipated risk and patient factors. We encourage the development of a decision aid for FP in pediatric oncology.

Cancer Center Amsterdam Amsterdam University Medical Center Vrije Universiteit Medical Center 1007 MB Amsterdam The Netherlands

Clinic for Paediatric and Adolescent Medicine Medical Faculty of the Martin Luther University of Halle Ernst Grube Str 40 06120 Halle Germany

Department of Haematology Oncology Erasmus MC Sophia Children's Hospital 3000 CA Rotterdam The Netherlands

Department of Haematology Oncology Royal Hospital for Sick Children Edinburgh EH16 4TJ UK

Department of Paediatric Haematology and Oncology KU Leuven UZ Leuven Herestraat 49 3000 Leuven Belgium

Department of Pediatric Hematology and Oncology Faculty Hospital Motol and 2nd Medical Faculty Charles University 5 Úvalu 84 150 06 Prague 5 Czech Republic

Department of Pediatric Hematology and Oncology Universitätsklinikum Giessen und Marburg GmbH Standort Giessen Zentrum für Kinderheilkunde und Jugendmedizin Feulgenstr 12 35392 Giessen Germany

Department of Reproductive Medicine and Gynecology University Medical Center Utrecht 3584 CX Utrecht The Netherlands

Emma Children's Hospital Amsterdam University Medical Center Vrije Universiteit Amsterdam Pediatric Oncology Cancer Center Amsterdam 1007 MB Amsterdam The Netherlands

Pediatric Hematology and Oncology St Anna Children's Hospital Medical University of Vienna Kinderspitalgasse 6 A 1090 Wien Austria

Princess Máxima Center for Pediatric Oncology 3584 CS Utrecht The Netherlands

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