Abstract
To prevent ovarian dysfunction due to total body irradiation, we started ovarian shielding at our center (Saitama Medical Center, Jichi Medical University (SMC-JMU)) with a long source axis distance, which is different from the original method used at the University of Tokyo Hospital (UTH). We retrospectively analyzed the outcome of eight patients with a median age of 20.5 years from SMC-JMU and compared the results with the published data for eight patients with a median age of 22 years from UTH. The recovery of ovarian function was observed in five and six patients, respectively. The cumulative incidence of ovarian recovery, while treating relapse and death without ovarian recovery as competing risks, was 68.8 % at 2 years after transplantation in the total population, and there was no statistically significant difference between the two institutions (p = 0.85). Age and the history of previous chemotherapy did not affect the incidence of ovarian recovery. Two patients from each center had a relapse of leukemia. Overall, among the 11 patients who have survived without relapse, only one has not achieved ovarian recovery. In conclusion, ovarian shielding with both methods strongly protected ovarian function. However, we should continue to monitor the relapse rate among patients who undergo this procedure.
Similar content being viewed by others
References
Socie G, Salooja N, Cohen A, Rovelli A, Carreras E, Locasciulli A, Korthof E, Weis J, Levy V, Tichelli A (2003) Nonmalignant late effects after allogeneic stem cell transplantation. Blood 101(9):3373–3385
Okuda S, Sato M, Terasako K, Kako S, Oshima K, Kanda Y (2009) Should busulfan-containing regimen be avoided for young female patients undergoing hematopoietic stem cell transplantation? Bone Marrow Transplant 43(3):261–262. doi:10.1038/bmt.2008.309
Levine J, Canada A, Stern CJ (2010) Fertility preservation in adolescents and young adults with cancer. J Clin Oncol 28(32):4831–4841. doi:10.1200/JCO.2009.22.8312
Kuwayama M, Vajta G, Kato O, Leibo SP (2005) Highly efficient vitrification method for cryopreservation of human oocytes. Reprod BioMed Online 11:300–308
Nagashima T, Muroi K, Kawano-Yamamoto C, Miyoshi T, Ohmine K, Toshima M, Miyazato A, Takatoku M, Nagai T, Mori M, Komatsu N, Ozawa K (2005) Autologous gamete cryopreservation before hemopoietic stem cell transplantation. Med Sci Monit 11(3):CR91–CR94
Courbiere B, Prebet T, Mozziconacci MJ, Metzler-Guillemain C, Saias-Magnan J, Gamerre M (2010) Tumor cell contamination in ovarian tissue cryopreserved before gonadotoxic treatment: should we systematically exclude ovarian autograft in a cancer survivor? Bone Marrow Transplant 45(7):1247–1248. doi:10.1038/bmt.2009.313
Loren AW, Mangu PB, Beck LN, Brennan L, Magdalinski AJ, Partridge AH, Quinn G, Wallace WH, Oktay K (2013) Fertility preservation for patients with cancer: American society of clinical oncology clinical practice guideline update. J Clin Oncol 31(19):2500–2510. doi:10.1200/JCO.2013.49.2678
Nakagawa K, Kanda Y, Yamashita H, Hosoi Y, Oshima K, Ohtomo K, Ban N, Yamakawa S, Nakagawa S, Chiba S (2006) Preservation of ovarian function by ovarian shielding when undergoing total body irradiation for hematopoietic stem cell transplantation: a report of two successful cases. Bone Marrow Transplant 37(6):583–587
Nakagawa K, Kanda Y, Yamashita H, Nakagawa S, Sasano N, Ohtomo K, Oshima K, Kumano K, Ban N, Nannya Y, Kurokawa M, Chiba S (2008) Ovarian shielding allows ovarian recovery and normal birth in female hematopoietic SCT recipients undergoing TBI. Bone Marrow Transplant 42(10):697–699. doi:10.1038/bmt.2008.234
Gray RJ (1988) A class of k-sample tests for comparing the cumulative incidence of a competing risk. Ann Stat 16:1141–1154
Kanda Y (2013) Investigation of the freely available easy-to-use software 'EZK' for medical statistics. Bone Marrow Transplant 48(3):452–458
Scott BL, Sandmaier BM, Storer B, Maris MB, Sorror ML, Maloney DG, Chauncey TR, Storb R, Deeg HJ (2006) Myeloablative vs nonmyeloablative allogeneic transplantation for patients with myelodysplastic syndrome or acute myelogenous leukemia with multilineage dysplasia: a retrospective analysis. Leukemia 20(1):128–135. doi:10.1038/sj.leu.2404010
Oshima K, Kanda Y, Nakasone H, Arai S, Nishimoto N, Sato H, Watanabe T, Hosoya N, Izutsu K, Asai T, Hangaishi A, Motokura T, Chiba S, Kurokawa M (2008) Decreased incidence of acute graft-versus-host disease by continuous infusion of cyclosporine with a higher target blood level. Am J Hematol 83(3):226–232. doi:10.1002/ajh.21087
Kanda Y, Sakamoto K, Ashizawa M, Sato M, Terasako K, Kikuchi M, Kimura SI, Okuda S, Kako S, Oshima K (2011) Risks and benefits of ovarian shielding in female patients undergoing TBI: a decision analysis. Bone Marrow Transplant 46(8):1145–1147. doi:10.1038/bmt.2010.240
Acknowledgments
Authors thank Shinobu Nakabayashi, Hitoshi Matsuzaki, and Masato Sagehashi for their expert technical support to perform ovarian shielding.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Kanda, Y., Wada, H., Yamasaki, R. et al. Protection of ovarian function by two distinct methods of ovarian shielding for young female patients who receive total body irradiation. Ann Hematol 93, 287–292 (2014). https://doi.org/10.1007/s00277-013-1852-8
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00277-013-1852-8