ESPEYB19 9. Oncology and Chronic Disease Fertility issues and reproductive outcomes in childhood cancer survivors (9 abstracts)
9.7. Fertility status among long-term childhood acute lymphoblastic leukaemia survivors enrolled between 1971 and 1998 in EORTC CLG studies: results of the 58 late adverse effects study
G. Rossi , M. Kicinski , S. Suciu , E. Vandecruys , G. Plat , A. Uyttebroeck , C. Paillard , M. Barbati , M.F. Dresse , P. Simon , O. Minckes , C. Pluchart , A. Ferster , C. Freycon , F. Millot , J. van der Werfften Bosch , C. Chantrain , R. Paulus , T. de Rojas , G. de Schaetzen , P. Rohrlich , Y. Benoit & C. Piette
On behalf of the European Organisation for Research and Treatment of Cancer (EORTC) Children’s Leukemia Group (CLG)caroline.piette@chuliege.be Human Reproduction, 2022; 37: 44–53. PMID: 34788455.
Brief Summary: This case-control study evaluated fertility status in childhood acute lymphoblastic leukaemia (ALL) survivors enrolled in the European Organisation for Research and Treatment of Cancer (EORTC) Children’s Leukemia Group (CLG) Late Adverse Effect (LAE) study. The enrolled patients had been treated for ALL between 1971 and 1998 with different protocols. Both patients and controls completed a questionnaire about fertility and parenthood. The results showed more common pregnancy problems among female survivors aged ≥10 years at ALL diagnosis, and higher risk of miscarriages among partners of male survivors. These findings were related to the damage induced by cranial radiotherapy (CRT) on the function of the hypothalamic-pituitary-gonadal axis, and to the effect of alkylating agents in inducing germline mutations.
The recent PanCareLIFE Consortium guidelines (1, 2), based on current childhood ALL treatment protocols (HSCT, low-dose alkylating agents (cyclophosphamide-equivalent dose <6000–8000mg/m2) and CRT), suggest that oocyte or embryo cryopreservation should be recommended before HSCT in post-pubertal female ALL patients. The same measures should be suggested in patients at high recurrence risk, before low-dose alkylating agents or CRT. Ovarian tissue cryopreservation should be suggested in pre-pubertal female ALL patients before HSCT. Sperm cryopreservation should be recommended before HSCT or testicular radiotherapy, low-dose alkylating agents or CRT in post-pubertal male ALL patients. In pre-pubertal male ALL patients, testicular tissue cryopreservation should be suggested before HSCT and testicular radiotherapy. The Authors underlined that the high percentage of fertility problems among controls could have affected the results. However, the large study group of patients affected by the same malignancy and the analysis of males and females separately add relevance to the results, which are very encouraging for ALL patients. One-to-one controls were matched by region, level of urbanization, sex and education, and this is undoubtedly the strongest point of the study. Nonetheless, other similar studies are needed in the near future, in view of the change in therapeutic approach to this malignancies (i.e. chimeric antigen receptor T-cells), that is now modifying the scenario of late adverse effects in ALL survivors.
References: 1. Mulder RL et al. Fertility preservation for female patients with childhood, adolescent, and young adult cancer: recommendations from the PanCareLIFE Consortium and the International Late Effects of Childhood Cancer Guideline Harmonization Group. Lancet Oncol 2021a; 22: e45–e56. 2. Mulder RL et al.; PanCareLIFE Consortium. Fertility preservation for male patients with childhood, adolescent, and young adult cancer: recommendations from the PanCareLIFE Consortium and the International Late Effects of Childhood Cancer Guideline Harmonization Group. Lancet Oncol 2021b; 22: e57–e67.
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ESPE Yearbook of Paediatric Endocrinology
ISSN 1662-4009 (Online)
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