Fertility after allogeneic haematopoietic stem cell transplantation in childhood and adolescence

Abstract

Infertility is a major late effect in patients receiving haematopoietic stem cell transplantation (HSCT). The aim of this study was to determine the proportion of patients having fertility impairment after allogeneic HSCT in childhood/adolescence and to identify the potential risk factors. Treatment and fertility data of paediatric patients with malignant and non-malignant diseases treated with allogeneic HSCT between 2000 and 2005 were collected from seven European centres. Data were obtained for 138 female and 206 male patients after a median follow-up of 6 years (range 3-12). The patients' median age was 13 years (range 4-28) at the time of years at the time of the enquiry. Seven children were born to the overall group, all at term and healthy. Fertility impairment was suspected in 69% males and 83% females. Start of treatment at age X13 years was a risk factor in females (odds ratio (OR) 4.7; 95% confidence interval (CI), 1.5 to 14.9), whereas pre-pubertal therapy was a risk factor in males (OR 0.4; 95% CI, 0.2 to 0.8). The major treatment-related risk factors were BU in females (OR 47.4; 95% CI, 5.4 to 418.1) and TBI in males (OR 7.7; 95% CI, 2.3 to 25.4). In light of the significant proportion of HSCT patients reviewed with impaired fertility, fertility conservation procedures should be considered for all patients undergoing HSCT, particularly those receiving TBI or BU-based preparative regimens.

Childhood to adult transition and long-term follow-up after blood and marrow transplantation

“…57 Literature indicates that such discussions occur ~10% of the time at the start of gonadotoxic therapy for adults. 62 Among children diagnosed with cancer, these discussions occur even more rarely, as it is a great challenge for physicians to bring up fertility amidst a conversation of life-threatening diagnoses and therapies.…”

Fertility After Allogeneic Hematopoietic Stem Cell Transplantation: A 23-Year Review From A Tertiary Hospital.

“…Younger age is associated with an increased likelihood of fertility recovery. 2 Previous studies indicated that fertility is most frequently preserved in patients receiving a transplant in the young adult age group (15-30 years). 8 This was supported by our study, which showed that age > 30 years at Allo-HSCT was related to increased risk of infertility.…”

“…Borgmann-Staudt et al reported that impaired fertility was observed 3-12 years after the treatment in 69% of male patients and 83% of female patients who received allo-HSCT at an early age. 2 High doses of alkylating agents and/or total body irradiation (TBI) as well as older age in women at the time of transplant were found to be related to gonadal dysfunction and infertility. 3 Recovery of fertility after HSCT therapy has been reported in both sexes; in males the rate of spermatogenesis may increase with time.…”

Spontaneous conception after autologous hematopoietic stem cell transplantation: a case report

“…2 While few cases of successful conception or spermatogenic recovery after HSCT, with chemotherapy alone, or combined with TBI conditioning, have been reported 1, [3][4][5][6][7][8][9][10][11][12] (Table 1), other studies assessing male fertility after HSCT have not reported any conception, highlighting the increased risk of altered reproductive function after HSCT. In 2010, the patient was still in complete remission.…”