Fertility preservation strategies for patients with lymphoma: a real-world practice survey among Fondazione Italiana Linfomi centers

Abstract

Background: Improvement in the prognosis of lymphomas in recent decades has allowed focus on reducing long-term toxicity of treatment, including infertility. The aim of this study was to assess the fertility preservation knowledge and practices among hematologic centers affiliated with Fondazione Italiana Linfomi (FIL) in Italy. Methods: A survey questionnaire was provided to 152 FIL centers between December 2019 and December 2020. Results: Responses from 58 centers (38%) were received. All respondents reported informing patients about treatment-related gonadotoxicity. A minority of patients (10% female, 20% male) refused fertility preservation due to personal reasons. The most common fertility preservation options offered to female patients were mature oocyte cryopreservation (43.1%), ovarian tissue cryopreservation (6.9%), and mature oocyte or ovarian tissue cryopreservation (39.7%). Six centers (10.3%) did not perform any procedures. All centers offered sperm cryopreservation for male patients. Challenges regarding the time intervals between lymphoma diagnosis and fertility consultation (up to 20 days) as well as between consultation and fertility preservation procedure (up to 40 days) were revealed. Conclusions: This survey provides insight into fertility preservation practices among Italian hematologic centers and points out an urgent need to improve close cooperation between hematologists and fertility preservation specialists in order to avoid unacceptable delays in lymphoma treatment.

Fertility preservation techniques in cervical carcinoma

“…The loss of the ovarian primordial follicles by a DNA-damage-induced apoptosis mechanism related to p53 activation is thought to be the major restraining effect of platinum derivatives [19] . Paclitaxel, a taxol byproduct, is also widely used in the treatment of gynecologic malignancies and has been proven to significantly decrease the maturation of antral follicles, as well as the viability of corpora lutea resulting in follicular atresia, as shown in mouse models [20] . Furthermore, bevacizumab is an anti-angiogenic agent commonly used to treat relapsing and/or metastatic cervical cancer.…”

“…[19] Paclitaxel, a taxol byproduct, is also widely used in the treatment of gynecologic malignancies and has been proven to significantly decrease the maturation of antral follicles, as well as the viability of corpora lutea resulting in follicular atresia, as shown in mouse models. [20] Furthermore, bevacizumab is an anti-angiogenic agent commonly used to treat relapsing and/or metastatic cervical cancer. Its combination with other drugs or by itself, is dangerous for the oocyte maturation due to Hypoxemia induced in ovaries, [21,22] while there are not available data on the potential toxicity on female reproductive organs by topotecan, a further chemoterapic drug frequently used in advanced gynecologic neoplasms.…”

Is motherhood still possible after pelvic carbon ion radiotherapy? A promising combined fertility-preservation approach

“…No less important than ovarian damage, RT also causes structural morphologic and vascular uterine sequelae that may translate into an increased risk in early and late miscarriages, abnormal placentation, pre-term deliveries, abnormal foetal position, intrauterine growth restriction (IUGR), low birth weight, and perinatal death. [3][4][5] Currently, oocyte cryopreservation is the suggested approach to preserve female fertility in an oncological setting 6,7 but might cause an increase in the blood level of estradiol that could raise concerns in case of expression of hormone receptors in tumours. 8,9 Ovarian transposition and ovariopexy are two other approaches described in oncofertility.…”

“…Currently, oocyte cryopreservation is the suggested approach to preserve female fertility in an oncological setting 6,7 but might cause an increase in the blood level of estradiol that could raise concerns in case of expression of hormone receptors in tumours. 8,9 Ovarian transposition and ovariopexy are two other approaches described in oncofertility.…”

Clinical Management of Long-Term Survivors after Classical Hodgkin Lymphoma and Diffuse Large B-Cell Lymphoma

“…Instead, mature oocyte cryopreservation often leads to delays in treatment commencement (an average of 22 days from first consultation to start of CT). As few data are available on the proportion of patients who opt for cryopreservation and their actual utilization rate, prospective registries should be created to better describe the potential of this technique [ 8 ].…”