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4925 The Outcome of Fertility Preservation Strategy in Female Hematopoietic Stem Cell Transplant Recipients of Reproductive Age. Retrospective Study from the Kanto Study Group for Cell Therapy

Program: Oral and Poster Abstracts
Session: 723. Allogeneic Transplantation: Long-term Follow-up, Complications, and Disease Recurrence: Poster III
Hematology Disease Topics & Pathways:
Research, Clinical trials, Clinical Research, Adverse Events
Monday, December 9, 2024, 6:00 PM-8:00 PM

Hiroaki Shimizu, MD, PhD1, Masahiro Ashizawa2*, Yoshihiro Inamoto, MD, PhD3, Jun Kato, MD, PhD4*, Shun-Ichi Kimura, MD5*, Masatsugu Tanaka, MD6*, Shokichi Tsukamoto, MD, PhD7, Ayaka Nishihara7*, Masako Toyosaki, MD8*, Yuki Nakajima, MD9*, Satoru Takada, MD10, Nobuyuki Aotsuka, MD, PhD11*, Tomomi Takei, MD12*, Maki Hagihara, MD, PhD9*, Katsuhiro Shono, MD, PhD13*, Yoshihiro Hatta, MD14, Yoshihiro Umezawa, MD, PhD15*, Nobuhiko Kobayashi, MD16*, Ken Naganuma17*, Chikako Ohwada, MD, PhD18 and Yoshinobu Kanda, MD, PhD19*

1Hematology Division, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Bunkyo-ku, Japan
2Division of Hematology, Department of Medicine, Jichi Medical University, Shimotsuke city, Japan
3Department of Hematopoietic Stem Cell Transplantation, National Cancer Center Hospital, Tokyo, Japan
4Division of Hematology, Keio university school of medicine, Shinjuku-Ku, JPN
5Division of Hematology, Jichi Medical University Saitama Medical Center, Saitama, Japan
6Department of Hematology, Kanagawa Cancer Center, Yokohama, Japan
7Department of Hematology, Chiba University Hospital, Chiba, Japan
8Department of Hematology/Oncology, Tokai University School of Medicine, Isehara, Japan
9Yokohama City University Medical Center, Yokohama, JPN
10Saiseikai Maebashi Hospital, Maebashi, JPN
11Department of Hematology and Oncology, Japanese Red Cross Narita Hospital, Narita, Chiba, Japan
12Japanese Red Cross Medical Center, Tokyo, Japan
13Department of Hematology, Chiba Aoba Municipal Hospital, Chiba, Japan
14Department of Medicine Division of Hematology and Rheumatology, Nihon University School of Medicine, Tokyo, Japan
15Tokyo Medical and Dental University, Bunkyo-Ku, TKY, JPN
16Department of Hematology, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
17Saitama Medical Center, Saitama Medical University, Kawagoe, JPN
18Department of Hematology, International University of Health and Welfare School of Medicine, Narita, Japan
19Division of Hematology, Jichi Medical University, Tochigi, Japan

Background: Conditioning regimens including high-dose chemotherapy and/or total body irradiation (TBI) often harm the gonads leading to infertility after hematopoietic stem cell transplantation (HSCT). Therefore, strategies to preserve fertility have been investigated to improve the quality of life of patients after HSCT. For female patients, oocyte collection followed by cryopreservation of oocytes or embryos is recommended in guidelines, but collecting oocytes before or during chemotherapy is challenging in patients with acute leukemia. For patients planned to receive TBI, ovarian shielding has been shown to achieve early ovarian function recovery after HSCT. However, only a few large-scale studies have evaluated the outcome of these strategies. Methods: We retrospectively investigated information on fertility preservation strategy and its outcome using a questionnaire among female recipients aged 16-42 years at HSCT, performed between 2001 and 2020 at 18 institutions in the Kanto Study Group for Cell Therapy. Results: This study included 201 autologous and 1421 allogeneic HSCT in 1379 patients with a median age of 32 years at HSCT. Oocytes or embryos were cryopreserved in 76 patients in total. Ovarian tissue cryopreservation was performed in 12. Of the 286 and 193 patients who underwent allogeneic HSCT with reduced-intensity conditioning (mainly for aplastic anemia) and who underwent autologous HSCT, respectively, 52 (18.2%) and 20 (10.3%) recovered menstruation and 8 (2.8%) and 13 (6.7%) became pregnant. On the other hand, of the 900 patients who underwent allogeneic HSCT with myeloablative conditioning, 26 (2.9%) recovered menstruation exclusively using TBI-regimens (>8Gy, 19 with ovarian shielding), but none who received busulfan-based regimens did so, and 10 (1.1%) became pregnant including spontaneous pregnancy in 5 (all after TBI with ovarian shielding), and 2 each using cryopreserved oocytes and egg donation, respectively. Overall, 42 pregnancies in 31 patients resulted in 32 deliveries. With regard to the feasibility of oocytes/embryos cryopreservation, 125 (11%) of the 1147 patients with available information were referred to a fertility specialist. The oocyte or ovarian tissue collection for cryopreservation was actually attempted in 49% (61 of 125 cases). Among patients with an available information on the number of cryopreserved oocytes/embryos, the median number of cryopreserved oocytes and embryos was 5 and 3, respectively, and the rate of cryopreserving at least 10 oocytes or at least 3 embryo was 41% of patients with cryopreserved oocytes/embryos. Information on the reason for no-referral was not collected, but may include low probability to harvest enough oocytes, refusal by the patients including those who already had children, and so on.Conclusion: Although cryopreservation of oocytes and embryos is challenging in patients with hematological malignancies, these assisted reproductive technologies and ovarian shielding during TBI appeared to contribute to pregnancy and delivery after HSCT.

Disclosures: Inamoto: Meiji Seika Pharma: Honoraria, Research Funding; Janssen: Honoraria. Hatta: Chugai Pharmaceutical Co., LTD.: Honoraria; Nihon Servier Co., LTD: Honoraria; Bristol-Myers Squibb Co: Honoraria; Phizer Japan Inc: Honoraria; Kyowa Hakko Kirin CO. LTD: Honoraria. Kanda: Asahi-kasei, MSD, Novartis, Pfizer, Sanofi, Chugai, Astellas, Kyowa-Kirin: Honoraria; Chugai, Kyowa-kirin, Asahi-kasei, Otsuka: Research Funding.

*signifies non-member of ASH