A multidisciplinary approach involving robust communication and cooperation among patient navigators, research scientists, gynecologists, hemato-oncologists, and reproductive biologists is necessary to assure a high standard of care and maintenance of fertility when treating girls and young women with cancer, according to a report published in the Annals of Oncology.
Oncofertility is emerging as an interdisciplinary field at the junction of reproductive medicine and cancer care to support and expand fertility options for young patients with cancer. Acute lymphocytic leukemia (ALL), acute myeloid leukemia (AML), non-Hodgkin lymphoma (NHL), and Hodgkin lymphoma (HL) are the most common hematologic cancers in girls and young women, and treatments such as alkylating chemotherapy and total body irradiation are aggressive and can be toxic to the ovaries.
The type and stage of cancer, dose of anticancer treatment regimen, and age of the patient at the beginning of therapy all affect the development of treatment-related gonadotoxicity and successive iatrogenic premature ovarian insufficiency and loss of fertility. Notably, in relapsed and refractory disease, intensification of treatment and/or additional treatment requirements could increase the likelihood of gonadotoxicity and could negatively affect fertility.
Preservation and restoration of fertility in these young female patients with hematologic malignancies include established options such as embryo freezing and egg freezing, debatable options such as oophoropexy and gonadal shielding, experimental options such as neoadjuvant cytoprotective pharmacotherapy, and alternative family building options such as gestational surrogacy.
“If fertility preservation options are rejected, contraindicated, infeasible, unavailable, or unsuccessful, adoption and third-party reproduction (egg donation, embryo donation, and surrogacy) can be offered as family building alternatives,” the researchers noted.
Although multiple national and international guidelines for the preservation of fertility in patients with cancer exist, these guidelines largely have remained unincorporated in standard practice. Effective integration of these guidelines and approaches could provide opportunities to preserve and restore fertility for young female patients prior to, during, and following chemotherapy and/or radiotherapy.
Salama M, Anazodo A, Woodruff TK. Preserving fertility in female patients with hematological malignancies: a multidisciplinary oncofertility approach [published online August 16, 2019]. Ann Oncol. doi: 10.1093/annonc/mdz284