Late Effects Of Chemotherapy Research Articles

Neoadjuvant chemotherapy in relation to long-term mortality in individuals cured of gastric adenocarcinoma.

Late effects of chemotherapy could affect mortality amongst cancer survivors. This study aimed to clarify if neoadjuvant chemotherapy for gastric adenocarcinoma influences the long-term survival in individuals cured of this tumour. This was a nationwide and population-based cohort study that included all individuals who underwent gastrectomy for gastric adenocarcinoma in Sweden between 2006 and 2015 and survived for ≥ 5years after surgery. The cohort was followed up until death or end of study period (31 December 2020). Multivariable Cox proportional hazards regression was used to provide hazard ratios (HR) with 95% confidence intervals (CI). The HR were adjusted for age, sex, comorbidity, education, calendar year, tumour sub-location, in-hospital complications, and splenectomy. Data came from medical records and nationwide registers. Amongst 613 gastric adenocarcinoma survivors, neoadjuvant chemotherapy (used in 269 patients; 43.9%) was associated with a decreased crude mortality rate (HR 0.66, 95% CI 0.46-0.96). However, the association attenuated and became statistically non-significant after adjustment for all confounders (HR 0.83, 95% CI 0.56-1.23) and after adjustments solely for age and comorbidity (HR 0.82, 95% CI 0.56-1.20). Stratified analyses did not reveal any statistically significant associations between neoadjuvant chemotherapy and long-term mortality in categories of age, sex, comorbidity, calendar year and tumour sub-location. Neoadjuvant chemotherapy did not decrease the long-term survival amongst gastric adenocarcinoma survivors. Patients who received neoadjuvant chemotherapy were a selected group characterised by younger age and fewer severe comorbidities and therefore with better chances of long-term survival.

Correlates of common concerns in older cancer survivors of leukemia and lymphoma: Results from the WHI-LILAC study.

e24031 Background: Older survivors of leukemia and lymphoma often experience long-term and late effects of chemotherapy, worsened by aging-related conditions such as functional and cognitive impairment, which may be inadequately addressed. In this study, we described common concerns in older survivors of leukemia and lymphoma, and assessed demographic and clinical factors associated with these concerns. Methods: We utilized data from the WHI LILAC study that recruited post-menopausal women aged 50 and 79 years. Participants who were diagnosed with leukemia and lymphoma after enrollment in WHI and answered at least half of the questions on current concerns in LILAC were included (n = 420). Participants were asked about 14 areas of current concerns common in cancer survivorship and to rate each from 0 (no concern) to 2 (major concern), with total score ranging 0-28. Linear regression was used to assess demographic and clinical factors associated with the concern score, and logistic regression for factors associated with the three most common concerns, with backward variable selection methods. Results: Mean age at assessment was 81 years (range 69-99) and 73% had non-Hodgkin lymphomas. Median time since diagnosis was 8.8 years (range 2.5-20.8 years). Seventy-two percent reported any concern; median concern score among these survivors was 3.5 (Q1-Q3, 2-5) (Table). Factors significantly correlated with the concern score were sadness, pain, loneliness, worse quality of life (QoL), lower physical functioning, more comorbidities, and greater prior symptom count (all p < 0.05). Significant factors correlated with common concerns were: 1) Fatigue/sleep: leukemia diagnosis, greater prior symptom count, feeling sad or depressed, reported distress, lower physical functioning; 2) Physical functioning/activity: public health insurance, older age, greater prior symptom count, reported pain, worse QoL, higher BMI; 3) Memory/concentration: prior chemotherapy or radiation, loneliness, worse QoL, greater prior symptom count (all p < 0.05). Conclusions: Almost three-quarter of survivors of leukemia and lymphoma reported at least one concern, with common concerns being fatigue/sleep, physical functioning/activity, and memory/concentration. A multicomponent intervention is needed to address these common concerns in older cancer survivors.[Table: see text]

Characterization of subclinical diastolic dysfunction by cardiac magnetic resonance feature-tracking in adult survivors of non-Hodgkin lymphoma treated with anthracyclines

BackgroundThe use of anthracycline-based chemotherapy is associated with the development of heart failure, even years after the end of treatment. Early detection of cardiac dysfunction could identify a high-risk subset of survivors who would eventually benefit from early intervention. Cardiac magnetic resonance feature-tracking (CMR-FT) analysis offers a practical and rapid method to calculate systolic and diastolic strains from routinely acquired cine images. While early changes in systolic function have been described, less data are available about late effects of chemotherapy in diastolic parameters by CMR-FT. The main goal of this study was to determine whether left ventricular (LV) early diastolic strain rates (GDSR-E) by CMR-FT are impaired in long-term adult survivors of non-Hodgkin lymphoma (NHL). Our secondary objective was to analyze associations between GDSR-E with cumulative anthracycline dose, systolic function parameters and myocardial tissue characteristics.MethodsThis is a single center cross-sectional observational study of asymptomatic patients in remission of NHL who previously received anthracycline therapy. All participants underwent their CMR examination on a 3.0-T scanner, including cines, T2 mapping, T1 mapping and late gadolinium enhancement imaging. Derived myocardial extracellular volume fraction was obtained from pre- and post-contrast T1 maps. CMR-FT analysis was performed using Trufi Strain software. The data obtained were compared between anthracycline group and volunteers without cardiovascular disease or neoplasia.ResultsA total of 18 adult survivors of NHL, 14 (77.8%) males, at mean age of 57.6 (± 14.7) years-old, were studied 88.2 (± 52.1) months after exposure to anthracycline therapy (median 400 mg/m2). Compared with controls, anthracycline group showed impaired LV global early diastolic circumferential strain rate (GCSR-E) [53.5%/s ± 19.3 vs 72.2%/s ± 26.7, p = 0.022], early diastolic longitudinal strain rate (GLSR-E) [40.4%/s ± 13.0 vs 55.9%/s ± 17.8, p = 0.006] and early diastolic radial strain rate (GRSR-E) [− 114.4%/s ± 37.1 vs − 170.5%/s ± 48.0, p < 0.001]. Impaired LV GCSR-E, GLSR-E and GRSR-E correlated with increased anthracycline dose and decreased systolic function. There were no correlations between GDSR-E and myocardial tissue characteristics.ConclusionsLeft ventricular early diastolic strain rates by CMR-FT are impaired late after anthracycline chemotherapy in adult survivors of non-Hodgkin lymphoma.

First person profile: George J. Bosl, MD: Former long-term chair of Memorial Sloan Kettering Cancer Center's Department of Medicine reflects on his multifaceted career.

First person profile: George J. Bosl, MD: Former long-term chair of Memorial Sloan Kettering Cancer Center's Department of Medicine reflects on his multifaceted career.

Brain Hyperconnectivity >10 Years After Cisplatin-Based Chemotherapy for Testicular Cancer.

Chemotherapy for testicular cancer (TC) has been associated with neurotoxic effects shortly post-treatment. Late effects of chemotherapy on brain function in this patient group are still unknown. In this study, we investigated differences between patients with and without chemotherapy in functional brain networks at rest and during an affective processing functional magnetic resonance imaging (fMRI) task on average >14 years post-treatment. In addition, we report on changes in cognitive functioning during survivorship by comparing present and previous performance on a neuropsychological test battery on average 11 years earlier (3 years post-treatment). Twenty-eight chemotherapy (43.1 ± 7.5 years) and 23 surgery-only (48.2 ± 9.5 years) TC survivors were examined using neurocognitive tests and 3T-fMRI >10 years after treatment end. Brain functional networks were identified using dual regression independent component analysis. Task fMRI was analyzed using a block design. Standardized domain change scores were calculated for each individual to assess cognitive change. TC patients in the chemotherapy group showed functional hyperconnectivity at rest in the precuneus network, sensory and motor function network, executive control network, and the ventral stream network when compared with surgery-only patients. Furthermore, hypoactivation was found when performing the affective processing task. Cognitive data revealed that both groups showed comparable patterns of change from 3 to 14 years after initial treatment. This study provides novel insights on the possible underlying neurobiological mechanisms of late neurotoxic effects of cisplatin-based chemotherapy. Present findings reveal that functional hyperconnectivity is widespread, possibly to compensate for the pathophysiological disturbances. This concurs with our previous findings of structural hyperconnectivity in white matter. Longitudinal multimodal imaging studies are warranted to further investigate the association between long-term structural and functional network connectivity data, as well as its relationship with cognitive changes.

Abstract LB-399: Aspirin reduces doxorubicin-induced senescence and early-aging in mice

Abstract Survivors of childhood cancers are often associated with the adverse late effects of earlier cancer treatments, including hearing loss, early menopause, osteoporosis, hypoplasia, fatigue, and infertility. While an accumulating body of evidence supports the hypothesis that cancer treatment is associated with accelerated aging, the mechanisms that lead to a functional decline or frailty remain elusive. Expression of cyclooxygenase-2 (COX2), a key enzyme in prostaglandin biosynthesis, is known to be increased in the tissues of aged humans and mice. We have previously found that transgenic expression of COX2 causes premature aging phenotypes in mice. Since it is well-known that COX2 expression is highly induced by various chemotherapeutic agents, we further investigated the possible link between COX2 and the late effects of chemotherapy. Treatment of juvenile mice with doxorubicin (DOX), an anthracycline-based chemotherapeutic agent, resulted in increased cellular senescence and premature aging in adult mice. Interestingly, tissue expression of COX2 persisted even at 11 weeks after cessation of DOX treatment. In addition, aspirin, a classical non-steroidal anti-inflammatory drug (NSAID), alleviated cellular senescence and early aging phenotypes in DOX-treated mice. Moreover, NSAIDs, either a selective or non-selective COX2 inhibitors, reduced the viability of senescent cells and down-regulated the levels of Bcl-xL and LC3b. Our results suggest that chemotherapy-induced COX2 may play an important role in the late effects of chemotherapy by inducing cellular senescence and further aging. Citation Format: Mingxiao Feng, Minsub Shim. Aspirin reduces doxorubicin-induced senescence and early-aging in mice [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr LB-399.

Therapy-related myeloid neoplasms: when genetics and environment collide.

Therapy-related myeloid neoplasms (t-MN) arise as a late effect of chemotherapy and/or radiation administered for a primary condition, typically a malignant disease, solid organ transplant or autoimmune disease. Survival is measured in months, not years, making t-MN one of the most aggressive and lethal cancers. In this Review, we discuss recent developments that reframe our understanding of the genetic and environmental aetiology of t-MN. Emerging data are illuminating who is at highest risk of developing t-MN, why t-MN are chemoresistant and how we may use this information to treat and ultimately prevent this lethal disease.

Vincristine-induced peripheral neuropathy in survivors of childhood acute lymphoblastic leukaemia.

Vincristine, an essential component of childhood acute lymphoblastic leukaemia (ALL) therapeutic protocols, is associated with dose-dependent neurotoxicity, but its long-term morbidity in treated children has not been clearly elucidated. The aim of this study is to determine the prevalence of vincristine-induced peripheral neuropathy (VIPN) among Malaysian childhood ALL survivors and its impact on motor function and quality of life. Survivors of childhood ALL aged 4-18 years who had completed chemotherapy for 2 years or more were evaluated for VIPN using both the clinical Total Neuropathy Score (cTNS) and nerve conduction studies. Motor function and quality of life of the survivors were assessed via the Bruininks-Oseretsky Test of Motor Proficiency Brief Form, Second Edition (BOT-2 Brief Form) and the Paediatric Quality of Life version 4.0 Generic Core Scales (PedsQL4.0) questionnaire, respectively. One hundred and one survivors with a duration of follow-up ranging from 2.0 to 10.3 years were recruited. Twenty-seven (26.7%) had abnormal cTNS scores and 69 (68.3%) had electrophysiological evidence of neuropathy. Of these, 16 (15.8%) had combined clinical and electrophysiological neuropathy (VIPN). Those previously treated on the intermediate- or high-risk treatment stratification arms had a higher risk of developing VIPN (67.3 vs. 32.7%; odds ratio [OR]: 9.06, 95% confidence interval [CI]: 1.14-71.86; P = 0.014). Survivors with VIPN had significantly lower quality of life scores in the physical (P = 0.024) and social domains (P = 0.039) compared with peers without VIPN, but no association with poorer motor function was observed. Sixteen percent of ALL survivors had VIPN. VIPN should be increasingly recognised as a late effect of chemotherapy, as it significantly affects physical and social function quality of life.

Lower cognitive performance and white matter changes in testicular cancer survivors 10 years after chemotherapy.

Chemotherapy (CT) is associated with adverse effects on cognition. Only few studies have investigated cognition in testicular cancer (TC) patients and studies on very late effects of CT on cognition are absent. Further, brain changes in relation to treatment have not been investigated in TC. The objective of the present study is to compare psychosocial functioning, cognitive performance and brain (micro)structure following surgery and CT for TC, against surgery (S)-only. Twenty-eight CT (43.1±7.5 y) and 23 S-only (48.2±9.5y) TC survivors on average 14 yr post-treatment were examined using questionnaires, neurocognitive tests, and 3T-MRI [Diffusion Kurtosis Imaging (DKI), T1-weighted and Fluid Attenuated Inversion Recovery]. A multivariate cognitive performance score (Mahalanobis distance) was calculated to indicate the grade of cognitive performance. Kurtosis parameters, gray matter, and white matter (WM) volume were calculated from MRI data. Overall, the CT group showed lower cognitive performance (5.35±1.7) compared with the S-only group (4.4±0.9; P=0.03; d=0.70). Further, TC patients reported more memory problems after CT. DKI revealed a significantly higher radial kurtosis after CT in several anterior and posterior brain areas (P<0.05, corrected), but this was unrelated to cognitive performance. This cross-sectional study suggests that men receiving CT for TC are at risk for long-term lower cognitive performance. Although CT affected WM microstructure, this was unrelated to cognitive performance. More extensive, preferably prospective studies are warranted to confirm these results and to provide more insight into the possible mechanisms behind the observed cognitive sequelae after treatment for TC.

Germ cell tumors: looking to the future.

Our knowledge about the management of men with germ cell tumors (GCTs) and its tumor biology continues to evolve. Vascular disease, metabolic syndrome, second malignant neoplasms, and hypogonadism occur after treatment for GCTs and the latency pattern resembles that seen in patients treated for Hodgkin lymphoma. Patients receiving treatment for GCTs should be informed not only of the near-term toxicity (experienced during or shortly after administration), but also the delayed and late effects of chemotherapy and the need for lifelong surveillance for all late outcomes, including late relapse. Recent data suggest that the treatment outcome of patients with intermediate-risk, poor-risk, and relapsed GCTs can be improved through multicenter trials that include the general oncology community. Finally, GCTs are a malignancy of primordial germ cells. Programmed differentiation is clinically evident in vivo and probably related to chemotherapy resistance. This biology has much clinical relevance, some of which is already in use.

Late effects of chemotherapy and radiotherapy in osteosarcoma and Ewing sarcoma patients

Patients with osteosarcoma and Ewing sarcoma have achieved longer survival over the past decades, but late side effects of chemotherapy and radiotherapy have become important concerns. The authors reviewed all patients with localized osteosarcoma or Ewing sarcoma who had been enrolled in the Italian Sarcoma Group neoadjuvant protocols from 1983 through 2006. Data were updated in December 2010 to determine 3 endpoints: the incidence of a secondary primary cancer (designated as "second malignant neoplasm" [SMN]), infertility, and cardiotoxicity. Data were available on 883 patients with osteosarcoma and 543 patients with Ewing sarcoma. In the osteosarcoma group, there were 39 SMNs (4.4%) in 36 patients; in the Ewing sarcoma group, 15 patients (2.8%) experienced a single SMN each. The cumulative 10-year and 20-year incidence of an SMN (±standard error) was 4.9% ± 0.9% and 6.1% ± 1.2%, respectively, in the osteosarcoma group and 3.4% ± 0.9% and 4.7% ± 1.6%, respectively, in the Ewing sarcoma group. The most common SMN in the osteosarcoma group was breast cancer (n = 11), and the most common SMN in the Ewing sarcoma group was radiotherapy-induced osteosarcoma (n = 6). After 20 years, the risk of developing an SMN increased, whereas the risk of a recurrence of the primary tumor decreased. Permanent sterility was more common in males than in females. Doxorubicin cardiotoxicity occurred in 18 patients with osteosarcoma (2%) and in 7 patients with Ewing sarcoma (1.3%). The awareness of late side effects in long-term survivors of primary bone cancers should encourage longer follow-up.

Reply to J. Hornberger et al

We thank Hornberger et al for their letter, and especially for their interesting updated economic analyses based on our study results. They demonstrate that use of the 21-gene recurrence score (RS) assay for estrogen receptor (ER) –positive, lymph node–negative breast cancer results in gains of quality-adjusted years of life and total direct medical savings, even when cost of the assay is included. We agree that their economic analysis may in fact underestimate gains and savings, given the intermediate and late effects of chemotherapy and the costs of treating these events (unmeasured in our study), which could not be factored into their model, as well as work productivity and other issues they mention in their letter. We are now in the early stages of a similar prospective study of treatment decisions in lymph node–positive, ER-positive breast cancer, based on the findings of the Southwest Oncology Group study which showed, like the lymph node–negative data, that patients with very low RS do not appear to benefit from chemotherapy. We would be interested in the findings from a similar economic analysis utilizing the 21-gene RS assay in node-positive, ER-positive breast cancer.

Perceptions on caring for adult survivors of childhood cancer in the primary care setting

9568 Background: Encouraging cure rates for childhood cancers have resulted in a population of adult childhood cancer survivors (CCS) that are at risk for late effects of cancer-directed therapy. Late effects often occur when CCS are older and receive routine medical care from internists and family practitioners. Our study identifies facilitators and barriers to providing optimal late effects screening as well as evaluating information sources primary care providers (PCPs) perceive as useful, including cancer treatment summaries, survivorship care plans, and Children's Oncology Group (COG) guidelines. Methods: We sampled 1,500 randomly selected general internal medicine and family practice physicians from the American Medical Association Physician Masterfile for a nationwide mail survey. We received 351 surveys with data. Using chi-squared tests or t-tests to compare responders and non-responders we found a higher response rate for family practice (30.2%) compared to general internal medicine (16.5%) (p&lt;.0001). Results were tabulated for descriptive purposes and linear regression and logistic regression were used for the multivariable modeling. Results: Most (84–86%) PCPs stated that they had never received a cancer treatment summary or survivorship care plan; despite this, greater than 90% thought these documents would be useful. Most PCPs (93%) had never used COG guidelines, but 86% agreed that they would follow their recommendations. A minority of PCPs perceived that their medical training was adequate to recognize late effects of chemotherapy (27.6%), cancer surgery (36.6%), and radiation therapy (38.1%). Conclusions: PCPs have a low level of awareness about the medical problems of CCS; receive inadequate training to recognize late effects; and infrequently utilize, cancer treatment summaries, survivorship care plans, and COG guidelines. By evaluating the perceptions of PCPs, we have identified problematic areas for future investigation and have begun to lay the groundwork for incorporating follow-up care for CCS into routine general medical practice. No significant financial relationships to disclose.

Toward a Risk-Based Assessment of the Adult Cancer Survivor: Late Effects of Chemotherapy

Survivorship care of the cancer patient has become a growing concern among oncologists and primary care physicians in communities across the country. It is now recognized as a distinct phase in the continuum of cancer care. There are an estimated 12 million Americans with a history of cancer looking to their oncologists and primary care physicians for assistance in navigating the difficult waters of survivorship. Although a concerted effort is underway, there are few evidence-based guidelines or recommendations for managing long-term and late effects of adult cancer survivors. The Children's Oncology Group has developed consensus guidelines to improve and standardize care of the survivors of childhood to young adult cancers. Their successful efforts could serve as a model for a similar undertaking to address the post-treatment care of adult survivors. In the absence of evidence-based or consensus guidelines, knowledge of late effects can inform and direct assessment of survivors presenting with late sequelae of chemotherapy agents.

Recovery of cellular immunity following chemotherapy for AIDS related non Hodgkin’s lymphoma

8582 Background: Late effects of chemotherapy on immunological parameters in AIDS-related systemic NHL have not been described. Methods: 105 consecutive patients were treated with infusional CDE chemotherapy and HAART and 68 survived more than 3 months following the chemotherapy. Their lymphocyte subsets and plasma HIV viral loads were measured at regular intervals for 2 years and values compared to baseline. Results: During chemotherapy, there were statistically significant falls in CD4 (helper T), CD8 (cytotoxic T) and CD19 (B) cell populations but no changes in the CD56 (natural killer) cell population. Amongst the 68 survivors, there were statistically significant increases in CD4, CD8, CD19 and CD56 populations during the first year of follow-up, compared to the values at the start of chemotherapy. The rises were most marked during the first 3 months of follow-up, and the median rise over the first year were +97 cells/mL for CD4, +318 cells/mL for CD8, +137 cells/mL for CD19 and +32 cells/mL for CD56. During the second year of follow-up further statistically significant rises were documented for CD4 and CD19 cell counts but not for CD8 or CD56 cell counts. Data are available for 43 patients at 2 years post chemotherapy and for these patients the median CD4 cell count rose from 165/mL (IQR: 62–252) at the start of chemotherapy to 270/mL (IQR: 174–445) 2 years after completing chemotherapy. At the start of chemotherapy only 27% patients had an undetectable HIV plasma viral load. This value rose to 69% at the completion of chemotherapy, to 79% at 3 months, 81% at 1 year and 90% at 2 years after completing chemotherapy. Much of the initial suppression of HIV viraemia is because 41% of the cohort were antiretroviral naïve and started HAART with their chemotherapy. During 244 years of follow-up following chemotherapy in these 68 survivors, 7 second primary tumours and 8 opportunistic infections were diagnosed. Conclusions: Chemotherapy and concomitant HAART for AIDS-related NHL does not cause prolonged suppression of lymphocyte subsets. These data should provide reassurance regarding the long term immunological consequences of chemotherapy in people with HIV. No significant financial relationships to disclose.

Immunologic recovery in survivors following chemotherapy for AIDS-related non-Hodgkin lymphoma

AbstractThe late effects of chemotherapy on immunologic parameters in AIDS-related non-Hodgkin lymphoma (NHL) have not been described. From a cohort of 105 consecutive patients treated with infusional chemotherapy and highly active antiretroviral therapy (HAART), 68 survived more than 3 months following the end of chemotherapy. Their lymphocyte subsets and plasma HIV viral loads were measured at regular intervals for 2 years and values compared with baseline. During chemotherapy, there were statistically significant falls in CD4 (helper T), CD8 (cytotoxic T), and CD19 (B) cell populations but no changes in the CD56 (natural killer [NK]) cell population. Among the 68 survivors, there were statistically significant increases in CD4, CD8, CD19, and CD56 cell populations during the first year of follow up, compared with the values at the start of chemotherapy. During the second year of follow up, there were further statistically significant rises in CD4 and CD19 cell populations, compared with the values at 12 months after chemotherapy. During 244 years of follow-up since chemotherapy in these 68 survivors, 7 second primary tumors and 8 opportunistic infections were diagnosed. Chemotherapy and concomitant HAART for AIDS-related NHL does not cause prolonged suppression of lymphocyte subsets. These data should provide reassurance regarding the long-term consequences of chemotherapy in these individuals.

Late effects of chemotherapy compared to bone marrow transplantation in the treatment of pediatric acute myeloid leukemia and myelodysplasia

Late effects of chemotherapy compared to bone marrow transplantation in the treatment of pediatric acute myeloid leukemia and myelodysplasia

#636 Late effects of chemotherapy versus bone marrow transplantation for the treatment of acute myeloid leukemia

#636 Late effects of chemotherapy versus bone marrow transplantation for the treatment of acute myeloid leukemia

IS FREQUENT FOLLOW-UP OF TREATED HODGKIN'S NECESSARY?

The purpose of routine follow-up visits after treatment for Hodgkin's disease is to provide reassurance to the patient, monitor for late effects of chemotherapy, and detect tumor relapse. This retrospective study examined the effectiveness of routine clinic visits for detecting relapse after Hodgkin's disease. Researchers …

Prospects for fertility after cancer chemotherapy.

D URING THE PAST two decades, major strides have been made in the curability of certain malignancies in young patients, particularly Hodgkin’s disease and non-Hodgkin’s lymphoma, testicular and germ cell cancers, and acute leukemia. In addition to conventional chemotherapy doses and schedules, high-dose chemotherapy programs are now more widely used in an attempt to improve disease-free survival. Gonadal failure is an important longterm sequelae of curative chemotherapy in young adults. It has far-reaching effects on patient self-esteem, sexuality, and quality of life. Although patients are often advised of the possibility of gonadal failure at the onset of cancer treatment, most physicians and patients are initially focused on the timely initiation of treatment rather than on preservation of fertility. Unlike other late effects of chemotherapy (eg, myelodysplasia, secondary leukemia, venoocclusive disease of the liver, and interstitial lung disease), there are certain preventive measures that may be taken in an attempt to preserve fertility. In males, sperm banking should be standard practice before beginning chemotherapy. In females, there is the option of oocyte and embryo cryopreservation (for future in vitro fertilization [IVFJ). In both sexes, hormonal manipulation has the potential to protect the gonads from chemotherapeutic toxicity. This article will review the current literature on gonadal toxicity of chemotherapy, as well as discuss the current options for preservation of fertility in young patients.