First delivery in a leukemia survivor after transplantation of cryopreserved ovarian tissue, evaluated for leukemia cells contamination

We discuss the first delivery following an autologous ovarian tissue re-transplantation in a sterile leukemia survivor after evaluation for minimal residual disease.

Like Comment

Volume 109, Issue 1, Pages 48–53

Authors:

Moran Shapira, M.D., Hila Raanani, M.D., Iris Barshack, M.D., Ninette Amariglio, M.D., Ph.D., Sanaz Derech-Haim, M.Sc., Meital Nagar Marciano, Ph.D., Eyal Schiff, M.D., Raoul Orvieto, M.D., Dror Meirow, M.D.

Abstract:

Objective

To describe a successful autologous ovarian tissue re-transplantation in a sterile leukemia survivor after evaluation for minimal residual disease and provide a review of the current literature.

Design

Presentation of a carefully designed workup taken to evaluate tissue for minimal residual disease, its limitations, and applicability to other patients. To date, there have not been any publications of auto-transplantations in leukemia survivors, owing to an estimated high risk for malignancy induction.

Setting

Large tertiary hospital.

Patient(s)

A 19-year-old acute myeloid leukemia patient underwent ovarian tissue cryopreservation during complete remission before bone marrow transplantation. After prolonged amenorrhea, the patient desired pregnancy. Laboratory tests showed antimüllerian hormone <0.1 ng/mL and FSH 116 mIU/mL. Ultrasound revealed no ovarian follicles.

Intervention(s)

Ovarian tissue cryopreservation and auto-transplantation. Histology, immunohistochemistry, FISH, next-generation sequencing, and xenotransplantation were done to evaluate thawed tissue samples for the presence of leukemia cells.

Main Outcome Measure(s)

Evidence for leukemia cells in thawed ovarian tissue, reproductive outcomes and live birth after transplantation, and leukemia-free survival.

Result(s)

Histology was negative for leukemia cells. Three severe combined immunodeficiency mice, grafted with tissue fragments, were followed for 6 months and showed no macroscopic/microscopic signs for leukemia. Fluorescence in situ hybridization for disease-specific gene rearrangement resulted in a read below the probe's cut-off. A next-generation sequencing panel of genes implicated in myeloproliferative disorders did not reveal any significant molecular event. Transplantation was performed, followed by ovarian stimulation and IVF, resulting in the delivery of healthy newborn. More than 2 years have elapsed since transplantation, and the patient is leukemia free.

Conclusion(s)

Harvesting during complete remission, combined with intense tissue evaluation before transplantation, allowed a safe, successful transplantation in an acute myeloid leukemia survivor.


Read the full text here.


Fertility and Sterility

Editorial Office, American Society for Reproductive Medicine

Fertility and Sterility® is an international journal for obstetricians, gynecologists, reproductive endocrinologists, urologists, basic scientists and others who treat and investigate problems of infertility and human reproductive disorders. The journal publishes juried original scientific articles in clinical and laboratory research relevant to reproductive endocrinology, urology, andrology, physiology, immunology, genetics, contraception, and menopause. Fertility and Sterility® encourages and supports meaningful basic and clinical research, and facilitates and promotes excellence in professional education, in the field of reproductive medicine.

1 Comments

Go to the profile of Emma Pastor Franqueza
Emma Pastor Franqueza over 1 year ago

I'm interested know about that work because I'm thinking that the La Fe Hospital in Spain do to me, And if it is possible I want more information, and to know if you kwon somtheing that do it more sure. Thank Emma, espaimuebles@gmail.com