Male infertility in long-term survivors after solid tumours treatment. in childhood - single institution experience.

Transkript

1 Kruseová J, Černíková J, Ganevová M, Keslová P, Kouřímová A, Lukš A, Starý J Department of Paediatric Haematology and Oncology, Charles University, Motol hospital, Prague, Czech Republic Centre of reproductive and reproductive genetics, Charles University, Motol hospital, Prague, Czech Republic Department of Paediatric, Charles University, Motol hospital, Prague, Czech Republic

2 4336 survivors total cohort Prague center CNS tumor Hodgkin Nephroblastoma ALL GCT NHL Neuroblastoma Histiocytosis MMT - other RBL ES/PNET MMT-Rhabdomyosarcoma Osteosarcoma Carcinoma other AML Hepatoblastom./HCC MDS other Melanoma Carcinoma - thyroid Carcinoma - Grawitz CML Pheochromocytoma

3 LEC Prague: regulary visit 3107 survivors solid tumor leukemia 604 (303 allo BMT)

4 Purpose retrospective study of fertility status of our cured male patients Material and methods 1,143 male survivors after child solid tumours > 15 years 96 male survivors after allo BMT > 15 years 1 spermiograms 2 FSH,LH, testo 3 survivors children

5 Spermiograms solid tumor cohort Treatment group: patients N96, spermiograms N100 Diagnosis:

6 Spermiograms solid tumor cohort Treatment group N96 median age of patiens 32,8 years (13-45,7 ear) Median time to measurement since the diagnosis 11,8 years (2-43,6 year) Control group N201 without oncology treatment Center of reproductive medicine 27,9 years (19,1-2,1year)

7 Spermiograms solid tumor cohort Treatment group azospermia 47 normospermia 26 oligospermia 23

8 Spermiograms solid tumor cohort Treatment group 73% vs. control group 15% p < 0,001

9 Spermiograms solid tumor cohort Age at the start of treatment! p < 0,05 Spermiogram results median min. max. Normospermia N=26 15,8 0,3 19,3 Azospermia N=47 11,4 0,5 20,9 Oligospermia N=23 15,4 1,6 18,6

10 Spermiograms allo BMT cohort 96 pt - 26 spermiograms median age 18 years (14-24 y.) median time to measurements 6 years ( 3-16 y. ) Azospermia 18 pt. (78%) Oligospermia 2 pt. ( 9%) Normospermia 3 pt. ( 13%) - no TBI

11 FSH, LH, testosteron 204 patients median age 24,8 years (15,3 44,3 y). median time to the measurements 14,1 years ( 2,1-36, 4y). diagnosis

12 FSH.LH, testosteron Normal results : 130 (64%) Pathologic results: 74 (36%) FSH, LH levels elevation 22 (11%) low testosteron Pathological results vs. Spermiograms 21/ 25 azospermia/oligospermia 84% 4/ 18 normospermia 22%

13 FSH.LH, testosteron vs. cytostatics 53% 41% 43% 23% 28% 11% 24% 24% 13% 16% 10% Pathological Normal 2% cyclophosphamide bleomycin cisplatin procarbazine vinblastine dacarbazine

14 Survivors children 104 male survivors 150 own children (2IVF own spermia) Hodgkin lym.31 NHL 10 nefroblastoma 12 ALL 11 GCT 7 Ewing 5 other 5 CNS 4 osteosarcoma 3 carcinoma 3 MMT 3

15 Survivors children 104 male survivor : 150 children vs. 160 female survivor : 331 children Why? psychological issue? different side effect of cytostatics?

16 CONCLUSION Risk factors for male infertility Age at the start of treatment! p < 0,05 Cytostatics : Procarbazine, Cisplatin, Bleomycin, Vinblastine, Cyclophosphamide, Dakarbazine Elevation of FSH, LH Children: male survivors < female survivors

17 NEXT STEPS PanCareLIFE WP2 b fertility guidelines? prepubertal patients survivors hormon levels + inhibin B spermiogram

18 LEC team Prague THANK YOU! Kruseová J. Ganevová M. Lukš A. Radvanská J. Bašeová J. Perníková I. Nováková L. Koloušková S. Kohoutová A. Groh A. Makovská A. Douchová M.