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Published on: October 25, 2024
Surgical Fertility Preservation Can Be Safely Performed Without Delaying Treatment for Children With Severe Aplastic
Christopher J McCauley1,2, Erin E Rowell1, Monica M Laronda2,3,4
1Division of Pediatric Surgery, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA.
Insights
Pediatric patients with severe aplastic anemia (SAA) undergoing transplantation face infertility risks. Surgical fertility preservation (FP) through ovarian or testicular tissue cryopreservation is a safe option for prepubertal children, with no complications observed in a recent study.
Area of Science:
- Pediatric Hematology
- Reproductive Endocrinology
- Oncology
Background:
- Severe aplastic anemia (SAA) treatment, like hematopoietic cell transplantation, poses a significant risk of infertility in pediatric patients.
- Prepubertal children undergoing SAA treatment lack established fertility preservation (FP) methods beyond surgical tissue cryopreservation.
Purpose of the Study:
- To evaluate the safety and outcomes of surgical fertility preservation (FP) in prepubertal pediatric patients with severe aplastic anemia (SAA) before hematopoietic cell transplantation.
- To assess the feasibility of ovarian tissue cryopreservation (OTC) and testicular tissue cryopreservation (TTC) in this high-risk pediatric cohort.
Main Methods:
- Prospective enrollment of pediatric patients with SAA in a surgical FP clinical protocol between 2015 and 2023.
- Evaluation of surgical approach and outcomes for 14 patients undergoing either OTC (n=7) or TTC (n=7).
- Application of a comprehensive standard of care pathway to manage surgical risks associated with profound cytopenias.
Main Results:
- No surgical complications were reported in any of the 14 pediatric patients who underwent fertility preservation procedures.
- Surgical FP, including both ovarian and testicular tissue cryopreservation, was successfully and safely achieved in the cohort.
- The study demonstrates the feasibility of utilizing a standardized care pathway for surgical FP in SAA patients.
Conclusions:
- Surgical fertility preservation via ovarian or testicular tissue cryopreservation is a safe and feasible option for prepubertal children with severe aplastic anemia.
- A comprehensive standard of care pathway effectively mitigates surgical risks, enabling successful FP before hematopoietic cell transplantation.
- This approach offers a vital option for preserving future fertility in pediatric SAA patients at high risk of infertility.
Abstract:
Pediatric patients with severe aplastic anemia (SAA) who undergo hematopoietic cell transplantation are at significantly increased risk of infertility. Pretransplant fertility preservation (FP) options for prepubertal children are surgical procedures: ovarian or testicular tissue cryopreservation (OTC and TTC). Bleeding and infection risk must be considered given profound cytopenias in these patients. We prospectively enrolled patients in a surgical FP clinical protocol at our institution from 2015 to 2023. We evaluated the approach and outcomes of all 14 patients with SAA who underwent surgical FP (TTC: n = 7; OTC: n = 7). No patients experienced a surgical complication related to FP. With our patient cohort, surgical FP was safely achieved utilizing a comprehensive standard of care pathway.
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