Challenges and Unmet Oncofertility Needs in Hematopoietic Stem Transplant Recipients in a Middle-Income Nation

Abstract

Lack of fertility assessment (FA) and counsel (FC) has a negative impact on quality of life in cancer survivors. Cryopreservation (CP) offers a possibility of future progeny in both males and females. Hematopoietic stem cell transplant (HSCT) recipients are a high-risk group, whose increased risk of relapse limits time off of therapy for CP. Our aim was to evaluate trends in pre and post-HSCT gonadal dysfunction (GD) in HSCT recipients in a referral center in Latin America. This is a retrospective single-center study that included patients who underwent HSCT at our institution from June 2000 to May 2018, whose baseline diagnosis was established at Inclusion criteria were met by 213 patients. Median age at diagnosis was 26 years and 64.8% were male. 70.4% were of low socioeconomic (SE) status (monthly income Median age at HSCT was 29 years. HSCT was autologous in 54.9%. Median time from diagnosis to HSCT was 15 months and was 3 months from last therapy to HSCT. Conditioning regimen was myeloablative (MA) in 87.1% (Figure 1). Full pre-HSCT biochemical FA was available in 71.8% of patients (n=153) being consistent with GD in 22.9% (n=35). Female gender was associated with pre-HSCT GD (p At 6 months post-HSCT 193 patients were evaluable. Only 47.7% (n=92) had full FA. GD was present in 47.8% (n=44) and was related to female gender (p=0.03). Within females increased median concentration of FSH (p Despite the young age of our cohort few patients received FC. CP was almost null due to SE constrains, accessibility, and limited therapy-free time. Only 1 of every 4 patients had biochemical evidence suggestive of GD pre-HSCT. Greater care must be taken to allocate intervals for CP while weighing risk of relapse. Factors related to GD were female gender, MA regimens in females, and GCT in males; possibly evidencing the role of the blood-testis barrier in decreasing intragonadal drug concentrations. The reduced proportion of post-HSCT FA evidences lack of awareness among clinicians. Our results show the great need of multidisciplinary approaches in HSCT recipients and resource-stratified guidelines to select those with the greatest potential to benefit from a fertility perspective.