Childhood cancer and hematological disorders negatively affect spermatogonial quantity at diagnosis: a retrospective study of a male fertility preservation cohort

For young boys with cancer or a non-malignant hematological disorder, conditioning therapy, abdominal/pelvic radiotherapy, and certain chemotherapies form a major risk for germ cell loss. Contradictory studies have investigated the direct effects of such diseases on the development of the prepubertal male gonad before mainline treatment. For health professionals to counsel pediatric patients in the best way, insights into which diseases and at what ages they may affect the germ cell pool is crucial. A recent multicenter retrospective cohort study performed by Masliukaite and colleagues aimed to determine the effects of different types of childhood cancer and hematological disorders on the quantity, distribution, and differentiation of spermatogonia from diagnosis to treatment initiation and after mainline treatment. 

Masliukaite and colleagues demonstrated that the spermatogonial quantity is already reduced in the testes from prepubertal boys with cancer or a severe hematological disorder before treatment when compared to healthy controls. This reduction seems to be disease dependent as patients with central nervous system tumors and hematological disorders were affected the most. Besides this, the diseases also adversely impacted spermatogonial distribution and differentiation. Irrespective of the disease type, the most prominent germ cell loss was observed in patients diagnosed at an age younger than 7 years.

The above-mentioned patient groups may be at high risk of a critical germ cell loss that can lead to permanent infertility after mainline treatment. Likewise, the high level of germ cell loss may affect the outcomes of an attempt of fertility preservation by testicular tissue banking. For this reason, patient counseling and the timing of the banking should be modified according to the patient’s diagnosis and age in parallel to the content of the mainline treatment regime. Especially for boys with sickle cell disease who are treated with hydroxyurea before undergoing conditioning therapy, more research is needed on the timing of fertility preservation. 

Today, there is still much debate on which paediatric mainline treatments and diseases truly give a significant risk of later infertility. Because of this, different inclusion criteria are used amongst fertility clinics for testicular tissue banking. To form a consensus, more multicentric research is needed on this topic.

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