Wallace WH, Anderson RA, Irvine DSFertility preservation for young patients with cancer: who is at risk and what can be offered? Lancet Oncol 6(4): 209-218

Department of Child Life and Health, The University of Edinburgh, Edinburgh, Scotland, United Kingdom
The Lancet Oncology (Impact Factor: 24.69). 05/2005; 6(4):209-18. DOI: 10.1016/S1470-2045(05)70092-9
Source: PubMed


Estimates suggest that by 2010, one in 715 people in the UK will have survived cancer during childhood. With increasing numbers of children cured, attention has focused on their quality of life. We discuss the causes of impaired fertility after cancer treatment in young people, and outline which patients are at risk and how their gonadal function should be assessed. With the report of a livebirth after orthotopic transplantation of cryopreserved ovarian tissue and the continued development of intracytoplasmic sperm injection for men with poor sperm quality, we assess established and experimental strategies to protect or restore fertility, and discuss the ethical and legal issues that arise.

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Available from: Richard A Anderson, Feb 10, 2014
    • "The improved survival rates for childhood cancer have led to a growing attention for long-term side effects. Testicular dysfunction is a devastating long-term side effect of both radiotherapy and chemotherapy that may result in infertility or subfertility, particularly in survivors of Hodgkin and non-Hodgkin lymphoma (HL and NHL) [1] [2] [3] [4] [5] [6] [7]. Testicular damage induced by chemotherapy is related to the alkylating agents used and their cumulative doses [8] [9] [10]. "
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    ABSTRACT: The purpose of our study was to assess the gonadal function in male survivors of childhood lymphoma. We studied 171 male survivors of childhood lymphoma (83 with B-cell non-Hodgkin lymphoma [B-NHL], 32 with T-cell non-Hodgkin lymphoma [T-NHL], 50 with Hodgkin lymphoma [HL], and 6 with anaplastic large-cell lymphoma [ALCL]), measuring follicle-stimulating hormone [FSH] and luteinizing hormone [LH] levels at a median age of 21.1 (17-30.4) years after a median delay of 9.3 (2-22.4) years from treatment. FSH levels were above normal range (≥10 IU/L) in 42.1% and LH levels ≥8 IU/L in only 8.9% of survivors. In multivariate analysis, only the following chemotherapeutic agents were associated with higher FSH or LH levels: cyclophosphamide (P < .0001, .04), lomustine (CCNU; P = .002, 0.04), and procarbazine (P < .0001, .07). No significant correlation was found between FSH or LH levels and age or pubertal status at diagnosis. Mean FSH level was significantly lower in NHL survivors treated more recently: 6 ± 5.1 IU/L in B-NHL survivors treated since 1986 versus 12.3 ± 5.4 IU/L for those treated before 1981 (P = .0001), and 6.8 ± 9.6 IU/L in T-NHL survivors treated since 1989 versus 9.4 ± 5.7 IU/L for those treated before 1989 (P = .035). In HL, mean FSH level was 12.4 ± 9.9 IU/L following procarbazine containing chemotherapy versus 3.4 ± 1.9 IU/L in the absence of procarbazine and increased significantly with the number of MOPP/OPPA (mechlorethamine, Oncovin [vincristine], procarbazine, and prednisone/Oncovin, procarbazine, and prednisone, and Adriamycin [doxorubicin]) courses received, from 6.8 ± 5.7 IU/L for 1-2 MOPP/OPPA to 12.6 ± 7.5 for 3-4 MOPP/OPPA and 19.6 ± 13.3 for more than 4 MOPP/OPPA (P for trend = .006). Testicular toxicity of alkylating agents on childhood lymphoma survivors is dose dependent and not correlated to diagnosis, age, or pubertal status at diagnosis.
    Pediatric Hematology and Oncology 11/2015; DOI:10.3109/08880018.2015.1085933 · 1.10 Impact Factor
    • "For the same reason, as previously noted by Wallace et al (2005), it is impossible to respect all the conditions for a valid informed consent at the point in time when it is needed. In the case of minors, one already needs to rely on informed assent and proxy-consent, but even those are difficult to obtain. "

    Human Reproduction 07/2015; 30(9). DOI:10.1093/humrep/dev176 · 4.57 Impact Factor
    • "Growing numbers of young girls and women are now surviving cancer, with an increase in 5-year relative survival rates from around 60% in 1975 to 82–86% in 2009 (Edwards et al., 2013). Unfortunately, one of the long-term consequences of these ever more effective treatments is destruction of the ovarian follicular reserve, with possible premature menopause and subsequent infertility (Meirow and Nugent, 2001; Wallace et al., 2005; Donnez et al., 2006; Anderson and Wallace, 2013). This has become an important quality-of-life issue for the increasing population of cancer survivors, making fertility preservation a priority concern for these patients once cured of their disease. "
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    ABSTRACT: What is the best source of ovarian cells for the artificial ovary: medulla or cortex, cryopreserved or fresh? Ovarian cells from fresh medullary tissue, which can be isolated in larger numbers, show higher viability and are able to improve graft vascularization. In a previous study, addition of endothelial cells along with ovarian cells was found to be crucial for formation of a well-vascularized ovary-like structure. This study is the first to evaluate both the effect of cryopreservation and the source of ovarian tissue on isolated ovarian cells. Prospective experimental study in an academic research unit using ovarian tissue from seven patients undergoing surgery for benign gynecologic disease. Ovarian tissue was retrieved from seven patients, with one half processed as fresh (fresh group) and the other half frozen and thawed before processing (frozen group). In each group, ovarian cells from the cortex and medulla were isolated separately, and their viability was tested using a calcein AM/ethidium homodimer viability assay. Fifty thousand cells were then encapsulated in fibrin and grafted to peritoneal pockets in nude mice (14 in all). Grafts recovered after 7 days were analyzed by immunohistochemistry for the presence of ovarian cells (vimentin), proliferation (Ki67) and graft vascularization (double CD34). Cell apoptosis was analyzed by TUNEL assay. Cryopreservation decreased ovarian cell yield (-2804 cells/mg, P = 0.015) and viability (-9.72%, P = 0.052) before grafting and had a considerable (5-fold, P = 0.2) but non-significant negative impact on ovarian cell presence in grafts. The medulla yielded many more cells (+3841 cells/mg, P < 0.001) with higher viability (+18.23%, P < 0.001) than did the cortex. Moreover, grafts with cells from the medulla exhibited a statistically significant 6.44- and 2.47-fold increase in human and total vascular surface area, respectively. P-values were adjusted for multiple testing using the Benjamini-Hochberg method to achieve a 10% false discovery rate and adjusted P-values < 0.1 were therefore considered significant. Pilot study involving a limited number of experiments. Knowing that fresh medullary tissue is the best source of stromal cells is important for construction of the artificial ovary, as isolated follicles require structural support and a rich vascular network for their survival and development. This work was supported by grants from the Fonds National de la Recherche Scientifique de Belgique (5/4/150/5 and 7.4518.12F), Fonds Spéciaux de Recherche, Fondation Saint Luc and Foundation Against Cancer, and donations from Mr Pietro Ferrero, Baron Frère and Viscount Philippe de Spoelberch. None of the authors have any conflicting interests to declare. © The Author 2015. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved. For Permissions, please email: journals.permissions@oup.com.
    Human Reproduction 05/2015; 30(7). DOI:10.1093/humrep/dev101 · 4.57 Impact Factor
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