一项关于接受血液干细胞移植的青春期前和青春期女孩生育力保存的前瞻性研究。
A Prospective Study on Fertility Preservation in Prepubertal and Adolescent Girls Undergoing Hematological Stem Cell Transplantation.
作者信息
Wikander Ida, Lundberg Frida E, Nilsson Hanna, Borgström Birgit, Rodriguez-Wallberg Kenny A
机构信息
Department of Reproductive Medicine, Division of Gynecology and Reproduction, Karolinska University Hospital, Stockholm, Sweden.
Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden.
出版信息
Front Oncol. 2021 Jun 30;11:692834. doi: 10.3389/fonc.2021.692834. eCollection 2021.
BACKGROUND
Hematological stem cell transplantation (HSCT) is an established method which has markedly increased the survival rate of hematologic malignancies since its introduction in the 1980's. The conditioning for HSCT has known gonadotoxic effects and often leads to premature loss of fertility. In this study we have prospectively followed a cohort of girls undergoing HSCT and studied the outcomes of fertility preservation treatments performed before or after HSCT, as well as the long-term reproductive outcome.
METHODS
In this one-center prospective study, 39 girls counselled for fertility preservation prior to or after conditioning for HSCT for malignant or benign diseases at childhood or adolescence between 1990 and 2017 were included. The patients were presented with the option to undergo cryopreservation of ovarian tissue or oocytes depending on their age and the time available. Follicle counts of the ovarian tissue and number of oocytes collected before or after HSCT were compared between patients treated for benign and malignant diseases. Hormone measurements post HSCT treatment, including FSH and AMH, reproductive outcomes and overall survival until January 2021 were investigated.
RESULTS
In total, 34 girls and adolescents underwent fertility preservation before or after HSCT. Before HSCT, ovarian tissue was cryopreserved in 15 patients and two patients had oocytes preserved. Thirteen patients cryopreserved ovarian tissue after HSCT and seven patients returned to cryopreserve oocytes. Follicles were present in all tissue samples collected prior to HSCT, and in more than half of the samples collected post-HSCT. Half of the patients had spontaneous menarche or resumed menstruation post HSCT. Overall, 35 patients had survived at end of follow up and 7 patients had achieved parenthood.
CONCLUSIONS
Since fertility loss is common following HSCT, fertility preservation should be offered to all patients. Fertility preservation treatments can be performed both before and after HSCT.
CLINICAL TRIAL REGISTRATION
https://clinicaltrials.gov/show/NCT04602962, identifier NTC04602962.
背景
自20世纪80年代引入以来，造血干细胞移植（HSCT）已成为一种成熟的方法，显著提高了血液系统恶性肿瘤的生存率。HSCT预处理具有已知的性腺毒性作用，常导致生育能力过早丧失。在本研究中，我们前瞻性地追踪了一组接受HSCT的女孩，研究了HSCT前后进行的生育力保存治疗的结果以及长期生殖结局。
方法
在这项单中心前瞻性研究中，纳入了1990年至2017年期间因恶性或良性疾病在儿童期或青春期接受HSCT预处理前后接受生育力保存咨询的39名女孩。根据患者年龄和可用时间，为其提供卵巢组织或卵母细胞冷冻保存的选择。比较了良性和恶性疾病患者HSCT前后收集的卵巢组织卵泡计数和卵母细胞数量。研究了HSCT治疗后的激素测量，包括促卵泡生成素（FSH）和抗苗勒管激素（AMH）、生殖结局以及截至2021年1月的总生存率。
结果
共有34名女孩和青少年在HSCT前后进行了生育力保存。HSCT前，15名患者冷冻保存了卵巢组织，2名患者保存了卵母细胞。13名患者在HSCT后冷冻保存了卵巢组织，7名患者返回冷冻保存卵母细胞。HSCT前收集的所有组织样本中均有卵泡，HSCT后收集的样本中半数以上也有卵泡。半数患者在HSCT后自然月经初潮或恢复月经。总体而言，随访结束时35名患者存活，7名患者已为人父母。
结论
由于HSCT后生育能力丧失很常见，应向所有患者提供生育力保存。生育力保存治疗可在HSCT前后进行。
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