ESPEYB19 9. Oncology and Chronic Disease Fertility issues and reproductive outcomes in childhood cancer survivors (9 abstracts)
9.12. Pregnancy and pregnancy outcomes after hematopoietic stem cell transplantation in childhood: a cross-sectional survey of the EBMT pediatric diseases working party
Diesch-Furlanetto T , Rovó A , Galimard JE , Szinnai G , Dalissier A , Sedlacek P , Bodova I , Roussou VK , Gibson BE , Poiré X , Fagioli F , Pichler H , Faraci M , Gumy-Pause FG , Dalle JH , Balduzzi A , Bader P & Corbacioglu S
tamara.diesch@ukbb.ch.Hum Reprod. 2021; 36: 2871-82. PMID: 34529796.
Brief Summary: This retrospective study of the European Society for Blood and Marrow Transplantation (EBMT) registry describes the natural or assisted conceptions and their outcomes in patients <18-year-old at their first transplantation who received hematopoietic stem cell transplantation (HSCT) between 1995 and 2016.
In total, 62,988 pediatric patients received a first HSCT in EBMT centers. Pregnancy was reported in 406 patients in the database. Details concerning the first pregnancy and pregnancy outcome were obtained using a questionnaire from 99 patients (24%). Of the 99 patients, 29 (29%) were men who reported a pregnancy of their partners. All the seven men who had received conditioning regimens with TBI achieved fatherhood but required assisted fertilization (5/7) or used their cryopreserved sperm (2/7). The median age at conception in women was 25.0 years, about 5 years lower than the age of healthy women at their first child’s birth, 52% of women conditioned with total body irradiation (TBI) and 96% of those conditioned without TBI conceived naturally. 90% of all conceptions ended in a live birth, 84.5% were at term and 93% had normal birthweight.
Conditioning regimens before HSCT are highly gonadotoxic, which leads to gonadal failure and pubertal development disorders. There are few population-based studies assessing the risk of future infertility in children after HSCT. This study highlights that conception after HSCT, even after myeloablative conditioning, is possible, even if the support of reproductive medicine is required in several cases. A limitation of this study is that the age at last follow-up was <17 years for 75% of patients in the EBMT pediatric dataset, therefore a more prolonged follow-up is needed to allow all patients to realize their reproductive potential and adequately estimate the cumulative incidence of conception.
Timely discussion and counseling regarding possible late effects of cancer treatment are important to support patients’ future family planning. Whenever possible, fertility preservation options should be illustrated to parents of children and adolescents at cancer diagnosis. The direct toxicity caused by alkylating agents and radiation on the ovaries severely reduces follicular reserve inducing premature menopause. This study highlights that, even after HSCT, there may be a “time window of opportunity” when fertility is preserved for conceiving naturally or with the support of reproductive medicine. A transient recovery of the ovarian function after a few year from HSCT had already been reported, mostly in women <25 years old, but the identification of these patients at the right time remains a challenge (1). Children should be followed regularly after cancer treatment to allow patients who could not benefit from fertility preservation options before HSCT to take advantage of the ‘fertility window of opportunity’ afterwards.
References: 1. Logan S, Perz J, Ussher JM, Peate M, Anazodo A. A systematic review of patient oncofertility support needs in reproductive cancer patients aged 14 to 45 years of age. Psychooncology 2018; 27: 401–409.
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ESPE Yearbook of Paediatric Endocrinology
ISSN 1662-4009 (Online)
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