PURPOSE OF REVIEW: Treatment for high-risk or relapsed haematological malignancy with haematopoietic stem cell transplantation is known to cause infertility.
Today, there are no established options for fertility preservation in pre-pubertal boys. This review aims to describe how therapy for haematological malignancy in childhood affects male fertility, and to summarize recent developments for fertility preservation in these patients.
RECENT FINDINGS: Eventual recovery of spermatogenesis is probable after chemotherapy-based conditioning for haematopoietic stem cell transplantation. However, conditioning with total body irradiation is associated with a very high risk of permanent infertility. For high-risk patients, auto-transplantation of cryopreserved testicular tissue or cells might represent an approach for fertility preservation; however, contamination of testis tissue with malignant cells may prevent their subsequent reintroduction into patients. Recent progress using in-vitro differentiation of germ cells combined with assisted reproductive techniques may, in the future, represent a suitable alternative to retransplantation.
SUMMARY: Particular care must be taken when assessing infertility risk in patients with haematological malignancy as reclassification to high risk may significantly increase the likelihood of treatment-related gonadotoxicity. Importantly, development of fertility preservation strategies in such high-risk patients must also take into account specific risks for haematological cancers including cancer cell contamination.
Written by:
Jahnukainen K, Mitchell RT, Stukenborg JB. Are you the author?
Pediatric Endocrinology Unit, Department of Women's and Children's Health, Karolinska Institutet and University Hospital, Stockholm, Sweden; Division of Haematology-Oncology and Stem Cell Transplantation, Children's Hospital, University of Helsinki, Helsinki University Central Hospital, Helsinki, Finland; MRC Centre for Reproductive Health, The Queen's Medical Research Institute, The University of Edinburgh; The Edinburgh Royal Hospital for Sick Children, Edinburgh, UK.
Reference: Curr Opin Endocrinol Diabetes Obes. 2015 Jun;22(3):217-23.
doi: 10.1097/MED.0000000000000156
PubMed Abstract
PMID: 25871959