State-of-the-art fertility preservation in children and adolescents undergoing haematopoietic stem cell transplantation: a report on the expert meeting of the Paediatric Diseases Working Party (PDWP) of the European Society for Blood and Marrow Transplantation (EBMT) in Baden, Austria, 29–30 September 2015

Abstract

Nowadays, allogeneic haematopoietic stem cell transplantation (allo-HSCT) is a well-established treatment procedure and often the only cure for many patients with malignant and non-malignant diseases. Decrease in short-term complications has substantially contributed to increased survival. Therefore long-term sequelae are reaching the focus of patient care. One of the most important risks of stem cell transplant survivors is infertility. As well as in the field of allo-HSCT also the field of reproductive medicine has achieved substantial advances to offer potential options for fertility preservation in both boys and girls. Access to these procedures as well as their financing differs significantly throughout Europe. As all European children and adolescents should have the same possibility, the Paediatric Diseases Working Party of the European Society for Blood and Marrow Transplantation organised an expert meeting in September 2015. This manuscript describes the recommendations for the diagnosis and pre-emptive procedures that should be offered to all children and adolescents in Europe who have to undergo an allo-HSCT.

Is Ovarian Tissue Cryopreservation and Transplantation Still Experimental? It Is a Matter of Female Age and Type of Cancer

“…Therefore, cryopreservation of ovarian tissue and transplantation must still be classified as experimental in children. This is in line with the recommendations of the expert meeting of the European Society for Blood Marrow Transplantation, 4 which also classified this technique as experimental.…”

Recent advances in fertility preservation

“…It is widely known that most cancer treatments like chemotherapy, radiotherapy or a combination of both are highly toxic to the gonads, putting girls and women of reproductive age at risk of premature ovarian insufficiency (POI) and subsequent infertility . Moreover, non‐oncological hematological diseases (thalassemia, aplastic anemia), autoimmune disorders (rheumatoid arthritis, systemic lupus erythematosus) and other ovarian pathologies, often require treatment that may impair future fertility, exponentially increasing the number of women likely to suffer from iatrogenic menopause or POI.…”

Urogenital Abnormalities in Adenosine Deaminase Deficiency

“…The use of a reduced-intensity conditioning regimen is expected to decrease HSCT-related side effects. Recently, the Pediatric Diseases Working Party of the European Society for Blood and Marrow Transplantation has established recommendations for the diagnosis and pre-emptive procedures that should be offered to all children and adolescents in Europe who undergo life-saving allogeneic SCT [12]. Emerging reports describe fertility and gonadal function in transplanted SCID [13][14][15], but actually, no specific studies on ADA-SCID have been performed.…”