Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Aug;70(8):e30407.
doi: 10.1002/pbc.30407. Epub 2023 May 17.

Fertility preservation in pediatric leukemia and lymphoma: A report from the Children's Oncology Group

Allison Close  1 , Karen Burns  2 , Kari Bjornard  3   4 , Martine Webb  5 , Josuah Chavez  6 , Eric J Chow  7 , Lillian Meacham  8
Affiliations

Fertility preservation in pediatric leukemia and lymphoma: A report from the Children's Oncology Group

Allison Close et al. Pediatr Blood Cancer. 2023 Aug.

Abstract

Certain chemotherapy agents, radiation, and surgery can all negatively impact future fertility. Consults regarding treatment-related risk for infertility and gonadal late effects of these agents should occur at the time of diagnosis as well as during survivorship. Counseling on fertility risk has traditionally varied significantly across providers and institutions. We aim to provide a guide to standardize the assignment of gonadotoxic risk, which can be used in counseling patients both at the time of diagnosis and in survivorship. Gonadotoxic therapies were abstracted from 26 frontline Children's Oncology Group (COG) phase III protocols for leukemia/lymphoma, in use from 2000-2022. A stratification system based on gonadotoxic therapies, sex, and pubertal status was used to assign treatments into minimal, significant, and high level of increased risk for gonadal dysfunction/infertility. Risk levels were assigned to protocols and different treatment arms to aid oncologists and survivor care providers in counseling patients regarding treatment-related gonadotoxicity. Males were most commonly at high risk, with at least one high-risk arm in 14/26 protocols (54%), followed by pubertal females (23% of protocols) and prepubertal females (15% of protocols). All patients who received direct gonadal radiation or hematopoietic stem cell transplant (HSCT) were considered at high risk. Partnering with patients and their oncology/survivorship team is imperative for effective fertility counseling both prior to and post treatment, and this comprehensive guide can be used as a tool to standardize and improve reproductive health counseling in patients undergoing COG-based leukemia/lymphoma care.

Keywords: fertility preservation; leukemia; lymphoma; oncofertility.

PubMed Disclaimer

Figures

Figure 1. –
Figure 1. –. Level of risk for gonadal failure/infertility above that of the general population
[A. Female Risk Level, B. Male Risk Level]. Reprinted with permission. CED – Cyclophosphamide equivalent dosing; RPLND – Retroperitoneal lymph node dissection
Figure 1. –
Figure 1. –. Level of risk for gonadal failure/infertility above that of the general population
[A. Female Risk Level, B. Male Risk Level]. Reprinted with permission. CED – Cyclophosphamide equivalent dosing; RPLND – Retroperitoneal lymph node dissection
Figure 2. –
Figure 2. –. Distribution of risk levels for treatment related gonadal failure/infertility for COG treatment protocols 2000–2022
[A. Acute Lymphoblastic Leukemia/Lymphoma, B. Acute Myeloid Leukemia, C. Hodgkin Lymphoma, D. Non-Hodgkin Lymphoma (excluding B-LLy/T-LLy) ].
See this image and copyright information in PMC

References

    1. van den Berg MH, Overbeek A, Lambalk CB, et al. Long-term effects of childhood cancer treatment on hormonal and ultrasound markers of ovarian reserve. Hum Reprod 2018;33:1474–88. - PubMed
    1. Chemaitilly W, Li Z, Krasin MJ, et al. Premature Ovarian Insufficiency in Childhood Cancer Survivors: A Report From the St. Jude Lifetime Cohort. J Clin Endocrinol Metab 2017;102:2242–50. - PMC - PubMed
    1. Green DM, Liu W, Kutteh WH, et al. Cumulative alkylating agent exposure and semen parameters in adult survivors of childhood cancer: a report from the St Jude Lifetime Cohort Study. Lancet Oncol 2014;15:1215–23. - PMC - PubMed
    1. Barton SE, Najita JS, Ginsburg ES, et al. Infertility, infertility treatment, and achievement of pregnancy in female survivors of childhood cancer: a report from the Childhood Cancer Survivor Study cohort. Lancet Oncol 2013;14:873–81. - PMC - PubMed
    1. Sklar CA, Robison LL, Nesbit ME, et al. Effects of radiation on testicular function in long-term survivors of childhood acute lymphoblastic leukemia: a report from the Children Cancer Study Group. J Clin Oncol 1990;8:1981–7. - PubMed

Publication types