Fertility and CAR T-cells: Current practice and future directions

Area of Science:

• Oncology
• Immunotherapy
• Reproductive Medicine

Background:

• Chimeric antigen receptor (CAR) T-cell therapy is effective for B-cell hematologic malignancies.
• As CAR T-cell use expands, understanding late effects like impacts on fertility is crucial.
• Current practices for fertility preservation and guidance around CAR T-cell therapy are not well-defined.

Purpose of the Study:

• To assess current practices regarding fertility counseling and outcomes surrounding CAR T-cell therapy.
• To identify gaps in fertility preservation and guidance for patients receiving CAR T-cell therapy.
• To explore future research needs in CAR T-cell therapy and reproductive health.

Main Methods:

• A cross-sectional survey was distributed to approximately 300 US and international centers administering CAR T-cell therapy.
• The survey assessed practice patterns for post-CAR T-cell fertility, peri-CAR T-cell fertility guidance, and fertility preservation.
• 96 responses were received, with 66 centers providing data for analysis.

Main Results:

• Seven pregnancies and five live births were reported across six centers following CAR T-cell therapy.
• Most centers lacked established guidelines for fertility preservation and pregnancy avoidance post-CAR T-cell treatment.
• Significant variability exists in peri-CAR T-cell guidance and fertility preservation referral practices.

Conclusions:

• This study is the first to report live births after CAR T-cell therapy, underscoring the need for fertility research.
• There is a critical need for standardized guidelines regarding fertility preservation and counseling for CAR T-cell recipients.
• Future research should focus on long-term fertility outcomes, fetal impact, and establishing best practices.