Treatment for high-risk or relapsed haematological malignancy with haematopoietic stem cell transplantation is known to cause infertility. Today, there are no established options for fertility preservation in pre-pubertal boys. This review aims to describe how therapy for haematological malignancy in childhood affects male fertility, and to summarize recent developments for fertility preservation in these patients.
Eventual recovery of spermatogenesis is probable after chemotherapy-based conditioning for haematopoietic stem cell transplantation. However, conditioning with total body irradiation is associated with a very high risk of permanent infertility. For high-risk patients, auto-transplantation of cryopreserved testicular tissue or cells might represent an approach for fertility preservation; however, contamination of testis tissue with malignant cells may prevent their subsequent reintroduction into patients. Recent progress using in-vitro differentiation of germ cells combined with assisted reproductive techniques may, in the future, represent a suitable alternative to retransplantation.
Particular care must be taken when assessing infertility risk in patients with haematological malignancy as reclassification to high risk may significantly increase the likelihood of treatment-related gonadotoxicity. Importantly, development of fertility preservation strategies in such high-risk patients must also take into account specific risks for haematological cancers including cancer cell contamination.
aPediatric Endocrinology Unit, Department of Women's and Children's Health, Karolinska Institutet and University Hospital, Stockholm, Sweden
bDivision of Haematology-Oncology and Stem Cell Transplantation, Children's Hospital, University of Helsinki, Helsinki University Central Hospital, Helsinki, Finland
cMRC Centre for Reproductive Health, The Queen's Medical Research Institute, The University of Edinburgh
dThe Edinburgh Royal Hospital for Sick Children, Edinburgh, UK
*Kirsi Jahnukainen, Rod T. Mitchell, and Jan-Bernd Stukenborg contributed equally to the writing of this aticle.
Correspondence to Kirsi Jahnukainen, MD, PhD, Division of Hematology-Oncology and Stem Cell Transplantation, Children's Hospital, Pl 281, FIN-00029 Helsinki, Finland. Tel: +358 40 5026351; e-mail: Kirsi.Jahnukainen@ki.se