Autotransplantation of cryopreserved ovarian tissue in cancer survivors and the risk of reintroducing malignancy: a systematic review

Abstract

BACKGROUND The risk of recurrent oncological disease due to the reintroduction of cancer cells via autotransplantation of cryopreserved ovarian tissue is unknown. METHODS A systematic review of literature derived from MEDLINE, EMBASE and the Cochrane Library was conducted. Studies on follow-up after autotransplantation; detection of cancer cells in ovarian tissue from oncological patients by histology, polymerase chain reaction or xenotransplantation; and epidemiological data on ovarian metastases were included. RESULTS A total of 289 studies were included. Metastases were repeatedly detected in ovarian tissue obtained for cryopreservation purposes from patients with leukaemia, as well as in one patient with Ewing sarcoma. No metastases were detected in ovarian tissue from lymphoma and breast cancer patients who had their ovarian tissue cryopreserved. Clinical studies indicated that one should be concerned about autotransplantation safety in patients with colorectal, gastric and endometrial cancer. For patients with low-stage cervical carcinoma, clinical data were relatively reassuring, but studies focused on the detection of metastases were scarce. Oncological recurrence has been described in one survivor of cervical cancer and one survivor of breast cancer who had their ovarian tissue autotransplanted, although these recurrences may not be related to the transplantation. CONCLUSIONS It is advisable to refrain from ovarian tissue autotransplantation in survivors of leukaemia. With survivors of all other malignancies, current knowledge regarding the safety of autotransplantation should be discussed. The most reassuring data regarding autotransplantation safety were found for lymphoma patients.

Efficacy of ovarian tissue cryopreservation in a major European center

“…This information is especially relevant as tissue has been cryopreserved for a large number of patients who may consider thawing and autotransplantation of their tissue in the future. [23] Furthermore, the effects of ovarian tissue transport on the tissue's condition, which could not be measured in the current study, should be further investigated. Since fertility preservation by means of cryopreservation of ovarian tissue is no longer considered experimental by some [24] and is applied on an increasing scale, efforts to optimize the laboratory phases have become imperative.…”

“…Although the efficacy of cryopreservation of ovarian tissue may thus differ from one center to another, information regarding these differences is scarce. [10,11] This is remarkable given the fact that the use of cryopreservation of ovarian tissue has increased considerably in the past decade [5,[12][13][14][15][16][17][18][19][20][21][22] with tissue from at least 2,500 patients now being stored at a limited number of highly experienced centers [23].…”

Fertility preservation in post-pubescent female cancer patients: A practical guideline for clinicians

“…This is of exceptional consideration in patients with hematologic malignancies (37), and is contraindicated in patients with leukemia (38), with extreme caution still required in solid tumors (39)(40)(41). Ideally, consideration for this procedure should be undertaken only in the context of a clinical trial, where follow-up for and reporting of recurrent cancer and pregnancies is feasible (33).…”

Is transplantation of a few leukemic cells inside an artificial ovary able to induce leukemia in an experimental model?

“…In another study, however, ovarian tissue from patients in complete remission did not appear to contain any viable malignant cells; although PCR results were positive, none of the grafted mice developed the disease [21]. Given the presence of leukemic cells and the uncertainty of disease transmission, reimplantation of ovarian tissue in young women with the acute form of leukemia is not currently recommended [13,22,23].…”