Sperm cryopreservation in patients with hematologic malignancies

Abstract

Many patients with acute leukemia or lymphoma are cured by chemotherapy or conditioning followed by hemopoietic stem cell transplantation. However, cancer chemotherapies and conditioning regimens deteriorate spermatogenesis. The greatest risk of infertility caused by chemotherapy is associated with alkylating agents such as cyclophosphamide, busulfan and melphalan, which are frequently used as conditioning in hemopoietic stem cell transplantation [1, 2]. Cyclophosphamide is the key drug for treatment of nonHodgkin lymphoma. Non-alkylating drugs such as anthracylines and cytarabine have been shown to have less effect or only a transient adverse effect on sperm production in children with acute leukemia [3, 4]. However, there are few reports on sperm production in adults with acute leukemia. Recently, Bahadur et al. [5] showed that gonadal toxic treatment for adult patients with leukemia or lymphoma results in significant reduction in sperm quality. Similar results were reported by Lemez and Urbanek [6]. Obviously, the best way to rescue infertility in adult male patients with leukemia, lymphoma or related disorders is sperm cryopreservation before the start of chemotherapy [7, 8]. We previously reported the results of a preliminary study showing that it is difficult to obtain the normal number of sperms in heavily treated patients with hematologic malignancies [9]. In this report, we summarize data on sperm collected for cryopreservation from patients with hematologic malignancies and describe successful spouse pregnancy using cryopreserved sperm from a patient with acute myeloid leukemia (AML). Before the start of initial chemotherapy, patients were informed of adverse effects related to chemotherapy, including mucositis, diarrhea, infections, secondary malignancies, and infertility. When male patients expressed a desire to cryopreserve their sperm, they were referred to private clinics conducting sperm banking. Data on sperm concentration and motility before cryopreservation were obtained from each clinic by letters in reply. From January 1999 to December 2007, sperm cryopreservation was performed for 38 patients with hematologic malignancies. Data on sperm from six patients previously reported [9] were included. The patients were divided into two groups: one group of the patients whose sperm was cryopreserved before the start of initial chemotherapy and another group of the patients whose sperm was cryopreserved after chemotherapy had been undertaken. Table 1 shows a summary of sperm conditions in the untreated patients. Six patients had AML including acute promyelocytic leukemia, two had acute lymphoblastic leukemia (ALL), eight had nonHodgkin lymphoma (NHL), five had lymphoblastic lymphoma (LBL) and one had myelodysplastic syndrome. The median age of the untreated patients was 27.5 years. All except two patients showed normal sperm concentration and motility. One patient (case 2) had normal sperm concentration but deteriorated sperm motility, while another (case 15) had extreme oligospermia. Table 2 shows a summary of sperm conditions in the treated patients. The treated patients included seven patients with AML, three with ALL, one with chronic myelogeneous leukemia, two with NHL and three with LBL. The median age of the treated patients was 32 years. Semen was repeatedly A. Meguro K. Muroi (&) T. Matsuyama M. Mori T. Nagai K. Ozawa Division of Hematology, Department of Medicine, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi 329-0498, Japan e-mail: muroi-kz@jichi.ac.jp