High-Dose Chemotherapy With Hematopoietic Stem Cell Transplant in Patients With High-Risk Breast Cancer

Abstract

pathologist (A.M.). Testicular histopathologic conditions were diagnosed for each individual, and the degree of spermatogenesis was quantified using the Johnsen scoring system. 4 Owing to the restrictive sample size, we present descriptive data on testicular pathologic conditions. Statistical analysis was performed from February 21, 2018, to December 12, 2019. Comparisons between cohorts for age at diagnosis, age at death, and time to autopsy were performed using a Mann-Whitney test using Prism, version 8 (GraphPad Software, Inc).Results | We queried more than 10 000 potential participants and identified a total of 13 men (median age, 54 years [range, 23-78 years]) with metastatic melanoma who had testicular autopsy tissue specimens available. Of these, 7 underwent immunotherapy and 6 were treatment naive. There was no difference between groups for age at diagnosis, age at death, and time to autopsy (Table ). Six of the 7 men (86%) with metastatic melanoma who received ICI therapy had impaired spermatogenesis, including focal active spermatogenesis (n = 1), hypospermatogenesis (n = 2), and Sertoli-cell-only syndrome (n = 3). Two of the 6 men (33%) who were untreated had impaired spermatogenesis (Figure). We did not identify any increased peritubular hyalinization or fibrosis in the treated group, and there were no Leydig cell abnormalities noted in any patients.Discussion | Fertility preservation is an important facet in the care of men with cancer who are within their reproductive years. 5,6 One key to improving cancer survivorship and quality of life is to anticipate potential treatment-associated sequelae. Identifying the association of ICIs with future fertility will be an important step in determining whether male fertility preservation is an essential component to pretreatment counseling. A limitation of our study was the small sample size. To our knowledge, the data herein are the first to evaluate the association of ICIs with testicular function, but prospective evaluations will be essential to determining the gonadotoxic effect of ICIs.