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Fertility Outcomes in Leukemia Survivors by Treatment Modality: A Systematic Review and Meta-Analysis
Judith Altmann1, Nadine Einsiedel1, Janna Pape2
1Department of Gynecology with Center of Oncological Surgery, Charité-Universitätsmedizin Berlin, Augusteburger Platz 1, 13353 Berlin, Germany.
Cancers
|August 13, 2026
Summary
Leukemia treatments like chemotherapy and stem cell transplants can impact fertility. Fertility preservation is crucial, especially for young patients facing intensive therapies and irradiation.
Area of Science:
- Oncology
- Reproductive Medicine
- Hematology
Background:
- Leukemia is a leading childhood cancer requiring intensive treatments.
- Fertility preservation (FP) is challenging in young leukemia patients due to treatment urgency and unpredictability.
- Females, in particular, face significant hurdles in FP before leukemia treatment.
Purpose of the Study:
- To systematically review and meta-analyze fertility outcomes in leukemia survivors.
- To quantify infertility rates associated with different leukemia treatment modalities.
- To identify sex-specific differences in fertility outcomes post-leukemia treatment.
Main Methods:
- Systematic review and meta-analysis of studies from MEDLINE, Embase, and Cochrane databases.
- Inclusion of 42 studies encompassing 2048 leukemia survivors.
- Data extraction on fertility outcomes, treatment types, and patient demographics.
Main Results:
- Overall infertility observed in 37% of leukemia survivors, with significant heterogeneity.
- Highest infertility rates linked to hematopoietic stem cell transplantation (HSCT) (68%) and irradiation (≥10-12 Gy TBI: 66%, testicular: 92%).
- Chemotherapy alone showed lower infertility (4%), but males had higher rates (18%) than females (6%) with chemotherapy-only regimens; females more affected post-HSCT (70% vs. 59%).
Conclusions:
- Standard chemotherapy has low gonadotoxicity, but HSCT and irradiation pose substantial fertility risks.
- Individualized fertility counseling and long-term reproductive follow-up are essential for leukemia survivors.
- Treatment-specific risks necessitate tailored reproductive health strategies for survivors.
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