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Fertility status in childhood cancer survivors of hematological malignancies: a systematic review

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Abstract

Stunning advances in treatment modalities implemented in children with hematological malignancies have led to 5-year overall survival rates exceeding 85%. However, this growing population of long-term survivors has raised significant concerns about their fertility status throughout adulthood, while specific treatment- and non-treatment-related factors appear to possibly affect fertility through distinct mechanisms. We aimed to comprehensively review the published literature on the association between treatment-related factors and risk of impaired fertility in childhood hematological cancer survivors. We searched PubMed up to March 2021 to identify eligible studies published during the last two decades. A narrative synthesis of the results was performed, although no meta-analysis was feasible due to the small number of studies and the large heterogeneity of evidence. Five studies on 2020 survivors of childhood leukemia were deemed eligible. The qualitative data synthesis showed significant fertility deficits in survivors treated with cranial radiotherapy and chemotherapy for childhood leukemia. Two studies examined biochemical measures of reduced ovarian reserve, providing some evidence that the levels of anti-Müllerian hormone can be used as a proxy for diminished ovarian reserve. The current findings should facilitate the delivery of age- and gender-appropriate interventions to optimize reproductive outcomes in childhood hematological cancer survivors.

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Authors and Affiliations

  1. 3rd Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, Attikon University Hospital, 1 Rimini Str, 12462, Athens, Greece

    Maria A. Karalexi, Adamantia Kontogeorgi, George Papaioannou, Pantelis Messaropoulos & Sophia N. Kalantaridou

  2. 2nd Department of Obstetrics and Gynecology, Aretaieion Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece

    Spyridoula Neofytou

  3. Pediatric Hematology/Oncology Unit, First Department of Pediatrics, National and Kapodistrian University of Athens, “Agia Sofia” Children’s Hospital, Athens, Greece

    Maria Moschovi

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  1. Maria A. Karalexi
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Contributions

MK and AK performed the literature search screening, data abstraction, and quality assessment; MK performed the narrative synthesis of the results; MK and AK drafted the initial version of the manuscript; SK conceived and designed the study. All authors drafted and critically revised the manuscript for important intellectual content, and gave final approval of the version to be published.

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Correspondence to Maria A. Karalexi.

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Karalexi, M.A., Kontogeorgi, A., Papaioannou, G. et al. Fertility status in childhood cancer survivors of hematological malignancies: a systematic review. Hormones 22, 211–221 (2023). https://doi.org/10.1007/s42000-023-00443-9

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