内容紹介
Fertility Preservation in Patients with Hematological Malignancies
Summary
Antineoplastic chemotherapy and irradiation affect gonadal function and may lead to infertility. Recovery of gonadal function is frequently observed after conventional chemotherapy in young patients with hematological malignancies, but conditioning regimens before hematopoietic stem cell transplantation result in permanent gonadal failure. Cryopreservation of sperm is effective for male patients, but it becomes difficult even after a single cycle of chemotherapy and therefore should be accomplished before starting chemotherapy. Embryo freezing after in vitro fertilization of harvested oocytes is an established method to preserve fertility in female patients. In addition, harvesting and freezing of unfertilized oocytes is also being evaluated in a clinical study. However, collection of good oocytes after chemotherapy is difficult. In addition, oocyte harvesting is an invasive procedure and may be associated with hemorrhage or infectious complications. Ovarian shielding during total body irradiation allows ovary preservation in most female patients, but this cannot be performed in patients with active malignancies. Strategies for gonadal function preservation should be planned before starting treatment for hematological malignancies.
要旨
化学療法や放射線治療は性腺に障害を与える。若年者の造血器腫瘍に対する通常の化学療法後は性腺機能回復がみられることも多いが,造血幹細胞移植の前処置は性腺機能に不可逆的な障害を及ぼす。妊孕性の維持のために男性患者は精子の凍結保存が可能である。しかし,化学療法後は良質な精子を数多く得ることが困難であり,可能な限り初回の化学療法を行う前に精子を採取する。女性患者も卵子を採取して受精卵あるいは未受精卵として凍結保存することができるが,急性白血病患者では化学療法の合間に良質な卵子を得ることは難しい。移植前の全身放射線照射時に卵巣を金属片で遮蔽すると移植後早期に卵巣機能が高頻度に回復するが,造血器腫瘍の再発率が増加しないかについては多数例の長期観察が必要である。
目次
Summary
Antineoplastic chemotherapy and irradiation affect gonadal function and may lead to infertility. Recovery of gonadal function is frequently observed after conventional chemotherapy in young patients with hematological malignancies, but conditioning regimens before hematopoietic stem cell transplantation result in permanent gonadal failure. Cryopreservation of sperm is effective for male patients, but it becomes difficult even after a single cycle of chemotherapy and therefore should be accomplished before starting chemotherapy. Embryo freezing after in vitro fertilization of harvested oocytes is an established method to preserve fertility in female patients. In addition, harvesting and freezing of unfertilized oocytes is also being evaluated in a clinical study. However, collection of good oocytes after chemotherapy is difficult. In addition, oocyte harvesting is an invasive procedure and may be associated with hemorrhage or infectious complications. Ovarian shielding during total body irradiation allows ovary preservation in most female patients, but this cannot be performed in patients with active malignancies. Strategies for gonadal function preservation should be planned before starting treatment for hematological malignancies.
要旨
化学療法や放射線治療は性腺に障害を与える。若年者の造血器腫瘍に対する通常の化学療法後は性腺機能回復がみられることも多いが,造血幹細胞移植の前処置は性腺機能に不可逆的な障害を及ぼす。妊孕性の維持のために男性患者は精子の凍結保存が可能である。しかし,化学療法後は良質な精子を数多く得ることが困難であり,可能な限り初回の化学療法を行う前に精子を採取する。女性患者も卵子を採取して受精卵あるいは未受精卵として凍結保存することができるが,急性白血病患者では化学療法の合間に良質な卵子を得ることは難しい。移植前の全身放射線照射時に卵巣を金属片で遮蔽すると移植後早期に卵巣機能が高頻度に回復するが,造血器腫瘍の再発率が増加しないかについては多数例の長期観察が必要である。