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Thrope A, Gerber LM, Thomas C, Antal Z. Longitudinal assessment of Leydig cell function in male survivors of childhood cancer. Pediatr Blood Cancer 2024; 71:e30829. [PMID: 38149843 PMCID: PMC10843544 DOI: 10.1002/pbc.30829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 12/06/2023] [Accepted: 12/14/2023] [Indexed: 12/28/2023]
Abstract
BACKGROUND As the number and longevity of childhood cancer survivors increases, assessing treatment-associated late effects remains crucial. We longitudinally examined the incidence of and associated risk factors for Leydig cell dysfunction (LCD) and Leydig cell failure (LCF) in men treated for pediatric cancers at our institution. PROCEDURE We performed a retrospective longitudinal cohort study of adult male survivors treated for various childhood cancers who are at risk for LCD. The outcomes of interest were serum testosterone and luteinizing hormone (LH) levels during childhood and adulthood. Risk factors assessed included treatment with stem cell transplant, total body irradiation (TBI), and exposure to alkylating agents. RESULTS Out of 118 eligible subjects, 7.6% had LCF and 14.4% had LCD. Median age at last testosterone level was 20 years. Subjects with sufficient testosterone levels in adulthood (N = 105) remained sufficient for a mean of 11.1 years following completion of cancer treatment. We found significant associations between LCF and treatment with TBI (p < .003) and between LCF in adulthood and testosterone insufficiency in childhood (p < .001). No statistically significant association was found between LCF and cyclophosphamide equivalent dose greater than 20 g/m2 (p = .2). LCF/LCD occurred in a small number of nonirradiated patients treated with the highest doses of alkylators. CONCLUSIONS Incidence of LCF and LCD are low in male survivors of childhood cancer. Longitudinally, there is an association between childhood testosterone insufficiency and LCF in adulthood. Alkylating agents and stem cell transplant without TBI were not associated with LCF in our study.
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Affiliation(s)
- Alexandra Thrope
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center New York, NY 10065
| | | | | | - Zoltan Antal
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center New York, NY 10065
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2
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Holst A, Ekman J, Petersson-Ahrholt M, Relander T, Wiebe T, Linge HM. Identifying causal relationships of cancer treatment and long-term health effects among 5-year survivors of childhood cancer in Southern Sweden. COMMUNICATIONS MEDICINE 2022; 2:21. [PMID: 35603279 PMCID: PMC9053221 DOI: 10.1038/s43856-022-00081-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 01/31/2022] [Indexed: 12/01/2022] Open
Abstract
Background Survivors of childhood cancer can develop adverse health events later in life. Infrequent occurrences and scarcity of structured information result in analytical and statistical challenges. Alternative statistical approaches are required to investigate the basis of late effects in smaller data sets. Methods Here we describe sex-specific health care use, mortality and causal associations between primary diagnosis, treatment and outcomes in a small cohort (n = 2315) of 5-year survivors of childhood cancer (n = 2129) in southern Sweden and a control group (n = 11,882; age-, sex- and region-matched from the general population). We developed a constraint-based method for causal inference based on Bayesian estimation of distributions, and used it to investigate health care use and causal associations between diagnoses, treatments and outcomes. Mortality was analyzed by the Kaplan–Meier method. Results Our results confirm a significantly higher health care usage and premature mortality among childhood cancer survivors as compared to controls. The developed method for causal inference identifies 98 significant associations (p < 0.0001) where most are well known (n = 73; 74.5%). Hitherto undescribed associations are identified (n = 5; 5.1%). These were between use of alkylating agents and eye conditions, topoisomerase inhibitors and viral infections; pituitary surgery and intestinal infections; and cervical cancer and endometritis. We discuss study-related biases (n = 20; 20.4%) and limitations. Conclusions The findings contribute to a broader understanding of the consequences of cancer treatment. The study shows relevance for small data sets and causal inference, and presents the method as a complement to traditional statistical approaches. Survivors of childhood cancer can develop late effects in adulthood. Knowledge about possible late effects can improve childhood cancer treatments and assist in follow-up. We developed a method to identify causative links between treatments and health outcomes. We applied it to a Swedish patient cohort and identified 98 causative links between treatments and outcomes, many of which are already known. Some, however, have not been previously described, including links between certain treatments and eye conditions or viral infections. We also confirm that childhood cancer survivors use more health care and have higher mortality compared to the general population. This study helps to create a better understanding of the late effects of cancer treatment in children and may help to guide strategies to monitor and treat children to avoid these effects. Holst et al. study the relationship between cancer treatments and long-term health effects using registry data on childhood cancer survivors in Sweden. The authors utilize a causal inference approach to establish relationships between certain therapies and viral infections, eye conditions, and reproductive conditions, amongst others.
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Tian En L, Brougham MFH, Wallace WHB, Mitchell RT. Impacts of platinum-based chemotherapy on subsequent testicular function and fertility in boys with cancer. Hum Reprod Update 2021; 26:874-885. [PMID: 32935838 PMCID: PMC7600277 DOI: 10.1093/humupd/dmaa041] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 08/10/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Children with cancer often face infertility as a long-term complication of their treatment. For boys, compromised testicular function is common after chemotherapy and currently there are no well-established options to prevent this damage. Platinum-based agents are used to treat a wide variety of childhood cancers. However, platinum agents are not currently included in the cyclophosphamide equivalent dose (CED), which is used clinically to assess the risks to fertility posed by combination chemotherapy in children with cancer. OBJECTIVE AND RATIONALE This was a systematic search of the literature designed to determine the evidence for effects of platinum-based cancer treatment on the prepubertal human testis in relation to subsequent testicular function and fertility. SEARCH METHODS PubMed and EMBASE were searched for articles published in English between 01 January 1966 and 05 April 2020 using search terms including 'cancer treatment', 'chemotherapy', 'human', 'prepubertal', 'testis', 'germ cells', 'testosterone' and related terms. Abstracts were screened and full-text articles were obtained for those that met the three major inclusion criteria (age ≤12 years at treatment, exposure to platinum-based chemotherapeutic and measure of reproductive function). Screening of bibliographies for full-text articles was used to identify additional studies. OUTCOMES Our initial search identified 1449 articles of which 20 (1.3%) studies (n = 13 759 males) met all inclusion criteria. A control group (healthy individuals or siblings) was included for 5/20 (25%) studies. A total of 10/20 (50%) studies provided sub-analysis of the relative gonadotoxicity of platinum-based agents.The primary outcome measures were: pregnancies and fatherhood; semen analysis; and hormonal function. For pregnancies and fatherhood, three studies (n = 10 453 males) reported negative associations with platinum-agents, including the largest (n = 5640) controlled study (hazard ratio = 0.56, P = 0.0023), whilst two other studies (n = 1781) with platinum sub-analysis reported no association. For semen analysis (based on World Health Organization criteria), platinum-based chemotherapy was associated with azoospermia in one study (n = 129), whilst another (n = 44) found no association and the remainder did not perform platinum-based sub-analysis. For hormone analysis, conflicting results were obtained regarding potential associations between platinum-based agents and elevated FSH (a proxy for impaired spermatogenesis); however, the majority of these studies were based on low numbers of patients receiving platinum-based chemotherapy. WIDER IMPLICATIONS Overall, these results indicate that platinum-based chemotherapy should be included in clinical calculators, for example CED, used to determine gonadotoxicity for childhood cancer treatment. These findings have important implications for clinicians regarding counselling patients and their carer(s) on fertility risk, guiding requirements for fertility preservation strategies (e.g. testicular tissue cryopreservation) and modification of treatments to reduce or eliminate the risk of infertility in childhood cancer survivors.
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Affiliation(s)
- Lim Tian En
- MRC Centre for Reproductive Health, The Queen's Medical Research Institute, The University of Edinburgh, Edinburgh, UK
| | - Mark F H Brougham
- Department of Paediatric Oncology, Royal Hospital for Sick Children, Edinburgh, UK
| | | | - Rod T Mitchell
- MRC Centre for Reproductive Health, The Queen's Medical Research Institute, The University of Edinburgh, Edinburgh, UK.,Department of Paediatric Endocrinology, Royal Hospital for Sick Children, Edinburgh, UK
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4
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Mulder RL, Font-Gonzalez A, Green DM, Loeffen EAH, Hudson MM, Loonen J, Yu R, Ginsberg JP, Mitchell RT, Byrne J, Skinner R, Anazodo A, Constine LS, de Vries A, Jahnukainen K, Lorenzo A, Meissner A, Nahata L, Dinkelman-Smit M, Tournaye H, Haupt R, van den Heuvel-Eibrink MM, van Santen HM, van Pelt AMM, Dirksen U, den Hartogh J, van Dulmen-den Broeder E, Wallace WH, Levine J, Tissing WJE, Kremer LCM, Kenney LB, van de Wetering MD. Fertility preservation for male patients with childhood, adolescent, and young adult cancer: recommendations from the PanCareLIFE Consortium and the International Late Effects of Childhood Cancer Guideline Harmonization Group. Lancet Oncol 2021; 22:e57-e67. [PMID: 33539754 DOI: 10.1016/s1470-2045(20)30582-9] [Citation(s) in RCA: 85] [Impact Index Per Article: 28.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 09/10/2020] [Accepted: 09/16/2020] [Indexed: 01/18/2023]
Abstract
Male patients with childhood, adolescent, and young adult cancer are at an increased risk for infertility if their treatment adversely affects reproductive organ function. Future fertility is a primary concern of patients and their families. Variations in clinical practice are barriers to the timely implementation of interventions that preserve fertility. As part of the PanCareLIFE Consortium, in collaboration with the International Late Effects of Childhood Cancer Guideline Harmonization Group, we reviewed the current literature and developed a clinical practice guideline for fertility preservation in male patients who are diagnosed with childhood, adolescent, and young adult cancer at age 25 years or younger, including guidance on risk assessment and available methods for fertility preservation. The Grading of Recommendations Assessment, Development and Evaluation methodology was used to grade the available evidence and to form the recommendations. Recognising the need for global consensus, this clinical practice guideline used existing evidence and international expertise to rigorously develop transparent recommendations that are easy to use to facilitate the care of male patients with childhood, adolescent, and young adult cancer who are at high risk of fertility impairment and to enhance their quality of life.
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Affiliation(s)
- Renée L Mulder
- Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands.
| | - Anna Font-Gonzalez
- Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands; Pediatric Oncology, Emma Children's Hospital, Amsterdam University, Amsterdam UMC, location AMC, Amsterdam, Netherlands
| | - Daniel M Green
- Department of Epidemiology and Cancer Control and Department of Oncology, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Erik A H Loeffen
- Department of Pediatric Oncology/Hematology, Beatrix Children's Hospital, UMC Groningen, University of Groningen, Groningen, Netherlands
| | - Melissa M Hudson
- Department of Epidemiology and Cancer Control and Department of Oncology, St Jude Children's Research Hospital, Memphis, TN, USA
| | | | - Richard Yu
- Boston Children's Hospital and Dana-Farber Cancer Institute, Harvard Medical School, Harvard Universty, Boston, MA, USA
| | - Jill P Ginsberg
- Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, University of Pennsylvania, Philadelphia, PA, USA
| | - Rod T Mitchell
- Medical Research Council Centre for Reproductive Health, University of Edinburgh, Edinburgh, UK
| | | | - Roderick Skinner
- Department of Paediatric and Adolescent Haematology/Oncology, Great North Children's Hospital, Newcastle upon Tyne, UK; Newcastle University Centre for Cancer, Newcastle upon Tyne, UK
| | - Antoinette Anazodo
- Kids Cancer Centre, Sydney Children's Hospital, Sydney, NSW, Australia; Nelune Comprehensive Cancer Centre, Prince of Wales Hospital, Sydney, NSW, Australia; School of Women's and Children's Health, University of New South Wales, Sydney, NSW, Australia
| | - Louis S Constine
- Department of Radiation Oncology and Department of Pediatrics, University of Rochester Medical Center, University of Rochester, NY, USA
| | - Andrica de Vries
- Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands; Department of Pediatric Hematology and Oncology, Sophia Children's Hospital, Erasmus MC, Rotterdam, Netherlands
| | - Kirsi Jahnukainen
- Children's Hospital, University of Helsinki, Helsinki, Finland; Helsinki University Central Hospital, Helsinki, Finland
| | - Armando Lorenzo
- Division of Urology, Hospital for Sick Children, Toronto, ON, Canada; Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Andreas Meissner
- Center for Reproductive Medicine, Amsterdam UMC, location AMC, Amsterdam, Netherlands; Department of Urology, Amsterdam UMC, location AMC, Amsterdam, Netherlands
| | - Leena Nahata
- Division of Endocrinology, Nationwide Children's Hospital, Columbus, OH, USA; Department of Pediatrics, The Ohio State University College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Marij Dinkelman-Smit
- Division of Andrology, Department of Urology, Erasmus MC, Rotterdam, Netherlands
| | - Herman Tournaye
- Centre for Reproductive Medicine, Free University of Brussels, Brussels, Belgium
| | - Riccardo Haupt
- Epidemiology and Biostatistics Unit and Livebirth Clinic, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Marry M van den Heuvel-Eibrink
- Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands; Department of Pediatric Hematology and Oncology, Sophia Children's Hospital, Erasmus MC, Rotterdam, Netherlands
| | - Hanneke M van Santen
- Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands; Department of Pediatric Endocrinology, Wilhelmina Children's Hospital, UMC Utrecht, Utrecht, Netherlands
| | - Ans M M van Pelt
- Laboratory for Reproductive Biology, Amsterdam UMC, location AMC, Amsterdam, Netherlands
| | - Uta Dirksen
- Department of Pediatrics III, West German Cancer Centre, Essen University Hospital, Essen, Germany; German Cancer Consortium (DKTK) Partner Site, Essen, Germany
| | - Jaap den Hartogh
- Dutch Childhood Cancer Parent Organization (VOX), Nieuwegein, Netherlands
| | - Eline van Dulmen-den Broeder
- Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands; Pediatric Oncology, Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - W Hamish Wallace
- Department of Paediatric Haematology and Oncology, Royal Hospital for Sick Children, Edinburgh, UK
| | - Jennifer Levine
- Division of Pediatric Hematology and Oncology, Weill Cornell Medicine, Cornell University, New York, NY, USA
| | - Wim J E Tissing
- Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands; Department of Pediatric Oncology/Hematology, Beatrix Children's Hospital, UMC Groningen, University of Groningen, Groningen, Netherlands
| | - Leontien C M Kremer
- Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands; Pediatric Oncology, Emma Children's Hospital, Amsterdam University, Amsterdam UMC, location AMC, Amsterdam, Netherlands
| | - Lisa B Kenney
- Boston Children's Hospital and Dana-Farber Cancer Institute, Harvard Medical School, Harvard Universty, Boston, MA, USA
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5
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Krawczuk‐Rybak M, Płonowski M, Leszczyńska E, Latoch E, Sawicka‐Żukowska M, Muszyńska‐Rosłan K, Skalska‐Sadowska J, Wachowiak J, Sga‐Pondel D, Kazanowska B, Chybicka A, Stachowicz‐Stencel T, Stefanowicz J, Malinowska I, Matysiak M, Kotan A, Wysocki M, Pobudejska‐Pieniążek A, Szczepański T, Przybyszewski B, Badowska W, Szymańska‐Miller D, Kowalczyk JR, Kamieńska E, Urasiński T, Wawrzeńczyk A, Żelazowska‐Rutkowska B, Cylwik B. The influence of different intensity of treatment on hormonal markers of gonadal function in acute lymphoblastic leukemia survivors. Hematol Oncol 2019; 37:609-616. [DOI: 10.1002/hon.2681] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2019] [Revised: 09/11/2019] [Accepted: 09/12/2019] [Indexed: 11/06/2022]
Affiliation(s)
- Maryna Krawczuk‐Rybak
- Department of Pediatric Oncology and HematologyMedical University of Bialystok Bialystok Poland
| | - Marcin Płonowski
- Department of Pediatric Oncology and HematologyMedical University of Bialystok Bialystok Poland
| | - Elżbieta Leszczyńska
- Department of Pediatric Oncology and HematologyMedical University of Bialystok Bialystok Poland
| | - Eryk Latoch
- Department of Pediatric Oncology and HematologyMedical University of Bialystok Bialystok Poland
| | | | | | - Jolanta Skalska‐Sadowska
- Department of Pediatric Hematology and Oncology and Hematopoietic Stem Cell Transplantation, Institute of PediatricsUniversity of Medical Sciences Poznan Poland
| | - Jacek Wachowiak
- Department of Pediatric Hematology and Oncology and Hematopoietic Stem Cell Transplantation, Institute of PediatricsUniversity of Medical Sciences Poznan Poland
| | - Dorota Sga‐Pondel
- Department and Clinic of Pediatric Oncology, Hematology and Bone Marrow TransplantationWroclaw Medical University Wroclaw Poland
| | - Bernarda Kazanowska
- Department and Clinic of Pediatric Oncology, Hematology and Bone Marrow TransplantationWroclaw Medical University Wroclaw Poland
| | - Alicja Chybicka
- Department and Clinic of Pediatric Oncology, Hematology and Bone Marrow TransplantationWroclaw Medical University Wroclaw Poland
| | | | - Joanna Stefanowicz
- Department of Pediatrics, Hematology and OncologyMedical University of Gdansk Gdansk Poland
| | - Iwona Malinowska
- Department of Pediatric Hematology and OncologyMedical University of Warsaw Warsaw Poland
| | - Michał Matysiak
- Department of Pediatric Hematology and OncologyMedical University of Warsaw Warsaw Poland
| | - Andrzej Kotan
- Department of Pediatric Hematology and Oncology, Collegium MedicumNicolaus Copernicus University Bydgoszcz Poland
| | - Mariusz Wysocki
- Department of Pediatric Hematology and Oncology, Collegium MedicumNicolaus Copernicus University Bydgoszcz Poland
| | | | - Teresa Szczepański
- Department of Pediatric Hematology and OncologyMedical University of Silesia Zabrze Poland
| | | | - Wanda Badowska
- Department of Hematology and OncologyChildren State Hospital Olsztyn Poland
| | | | - Jerzy R. Kowalczyk
- Department of Pediatric Hematology/OncologyMedical University Lublin Poland
| | - Elżbieta Kamieńska
- Department of Pediatrics, Hematology and OncologyPomeranian Medical University Szczecin Poland
| | - Tomasz Urasiński
- Department of Pediatrics, Hematology and OncologyPomeranian Medical University Szczecin Poland
| | - Anna Wawrzeńczyk
- Department of Pediatric Oncology and HematologyW. Buszkowski Children's Hospital Kielce Poland
| | | | - Bogdan Cylwik
- Department of Pediatric Laboratory DiagnosticsMedical University of Bialystok Białystok Poland
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6
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Gebauer J, Higham C, Langer T, Denzer C, Brabant G. Long-Term Endocrine and Metabolic Consequences of Cancer Treatment: A Systematic Review. Endocr Rev 2019; 40:711-767. [PMID: 30476004 DOI: 10.1210/er.2018-00092] [Citation(s) in RCA: 77] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Accepted: 06/21/2018] [Indexed: 02/08/2023]
Abstract
The number of patients surviving ≥5 years after initial cancer diagnosis has significantly increased during the last decades due to considerable improvements in the treatment of many cancer entities. A negative consequence of this is that the emergence of long-term sequelae and endocrine disorders account for a high proportion of these. These late effects can occur decades after cancer treatment and affect up to 50% of childhood cancer survivors. Multiple predisposing factors for endocrine late effects have been identified, including radiation, sex, and age at the time of diagnosis. A systematic literature search has been conducted using the PubMed database to offer a detailed overview of the spectrum of late endocrine disorders following oncological treatment. Most data are based on late effects of treatment in former childhood cancer patients for whom specific guidelines and recommendations already exist, whereas current knowledge concerning late effects in adult-onset cancer survivors is much less clear. Endocrine sequelae of cancer therapy include functional alterations in hypothalamic-pituitary, thyroid, parathyroid, adrenal, and gonadal regulation as well as bone and metabolic complications. Surgery, radiotherapy, chemotherapy, and immunotherapy all contribute to these sequelae. Following irradiation, endocrine organs such as the thyroid are also at risk for subsequent malignancies. Although diagnosis and management of functional and neoplastic long-term consequences of cancer therapy are comparable to other causes of endocrine disorders, cancer survivors need individually structured follow-up care in specialized surveillance centers to improve care for this rapidly growing group of patients.
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Affiliation(s)
- Judith Gebauer
- Experimental and Clinical Endocrinology, University Hospital of Schleswig-Holstein, Campus Luebeck, Luebeck, Germany
| | - Claire Higham
- Department of Endocrinology, Christie Hospital NHS Foundation Trust, Manchester, United Kingdom.,Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom
| | - Thorsten Langer
- Division of Pediatric Hematology and Oncology, University Hospital of Schleswig-Holstein, Campus Luebeck, Luebeck, Germany
| | - Christian Denzer
- Department of Pediatrics and Adolescent Medicine, Division of Pediatric Endocrinology and Diabetes, Ulm University Medical Center, Ulm, Germany
| | - Georg Brabant
- Experimental and Clinical Endocrinology, University Hospital of Schleswig-Holstein, Campus Luebeck, Luebeck, Germany.,Department of Endocrinology, Christie Hospital NHS Foundation Trust, Manchester, United Kingdom
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7
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Schneidewind L, Neumann T, Probst KA, Schmidt CA, Krüger W. Recovery from hypogonadism and male health in adult allogeneic stem cell transplantation. Eur J Haematol 2018; 100:584-591. [DOI: 10.1111/ejh.13052] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/19/2018] [Indexed: 02/04/2023]
Affiliation(s)
- Laila Schneidewind
- Department of Haemaotology/Oncology; University Medicine Greifswald; Greifswald Germany
| | - Thomas Neumann
- Department of Haemaotology/Oncology; University Medicine Greifswald; Greifswald Germany
| | - Kai A. Probst
- Department of Urology and Paediatric Urology; Westpfalz-Hospital; Kaiserslautern Germany
| | - Christian A. Schmidt
- Department of Haemaotology/Oncology; University Medicine Greifswald; Greifswald Germany
| | - William Krüger
- Department of Haemaotology/Oncology; University Medicine Greifswald; Greifswald Germany
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8
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Isaksson S, Bogefors K, Ståhl O, Eberhard J, Giwercman YL, Leijonhufvud I, Link K, Øra I, Romerius P, Bobjer J, Giwercman A. High risk of hypogonadism in young male cancer survivors. Clin Endocrinol (Oxf) 2018; 88:432-441. [PMID: 29245176 DOI: 10.1111/cen.13534] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Revised: 11/08/2017] [Accepted: 12/10/2017] [Indexed: 01/09/2023]
Abstract
OBJECTIVE Cancer and its treatment in childhood and young adulthood can cause hypogonadism, leading to increased risk of long-term morbidity and mortality. The aim of this study was to evaluate the risk of presenting with biochemical signs of hypogonadism in testicular cancer survivors (TCS) and male childhood cancer survivors (CCS) in relation to the type of treatment given. DESIGN Case-control study. PATIENTS Ninety-two TCS, 125 CCS (mean age 40 and median age 34 years, respectively; mean follow-up time 9.2 and 24 years, respectively) and a corresponding number of age-matched controls. MEASUREMENTS Fasting morning blood samples were analysed for total testosterone (TT), follicle-stimulating hormone (FSH) and luteinizing hormone (LH). The odds ratios (OR) for hypogonadism, defined as primary, secondary, compensated or ongoing androgen replacement, were calculated for TCS and CCS and for subgroups defined by diagnosis and treatment. RESULTS Hypogonadism was found in 26% of CCS and 36% of TCS, respectively (OR: 2.1, P = .025 and OR = 2.3, P = .021). Among CCS, the OR was further increased in those given testicular irradiation (OR = 28, P = .004). Radiotherapy other than cranial or testicular irradiation plus chemotherapy, or cranial irradiation without chemotherapy, associated also with increased ORs (OR = 3.7, P = .013, and OR = 4.4, P = .038, respectively). Among TCS, those receiving >4 cycles of cisplatin-based chemotherapy had OR = 17, P = .015. CONCLUSIONS Biochemical signs of testosterone deficiency are recognized as markers of decreased life expectancy. Thus, the risk of hypogonadism in TCS and CCS should be recognized and emphasizes the need of long-term follow-up for these men.
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Affiliation(s)
- S Isaksson
- Molecular Reproductive Medicine Unit, Department of Translational Medicine, Lund University, Malmö, Sweden
- Department of Oncology, Skane University Hospital, Malmö and Lund, Sweden
| | - K Bogefors
- Molecular Reproductive Medicine Unit, Department of Translational Medicine, Lund University, Malmö, Sweden
- Department of Oncology, Skane University Hospital, Malmö and Lund, Sweden
| | - O Ståhl
- Department of Oncology, Skane University Hospital, Malmö and Lund, Sweden
| | - J Eberhard
- Department of Oncology, Skane University Hospital, Malmö and Lund, Sweden
| | - Y L Giwercman
- Molecular Reproductive Medicine Unit, Department of Translational Medicine, Lund University, Malmö, Sweden
| | - I Leijonhufvud
- Molecular Reproductive Medicine Unit, Department of Translational Medicine, Lund University, Malmö, Sweden
- Reproductive Medicine Centre, Skane University Hospital, Malmö, Sweden
| | - K Link
- Molecular Reproductive Medicine Unit, Department of Translational Medicine, Lund University, Malmö, Sweden
| | - I Øra
- Department of Pediatrics, Pediatric Oncology, Clinical Sciences, Lund University, Lund, Sweden
| | - P Romerius
- Department of Pediatrics, Pediatric Oncology, Clinical Sciences, Lund University, Lund, Sweden
| | - J Bobjer
- Molecular Reproductive Medicine Unit, Department of Translational Medicine, Lund University, Malmö, Sweden
- Department of Urology, Skane University Hospital, Malmö, Sweden
| | - A Giwercman
- Molecular Reproductive Medicine Unit, Department of Translational Medicine, Lund University, Malmö, Sweden
- Reproductive Medicine Centre, Skane University Hospital, Malmö, Sweden
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9
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Skinner R, Mulder RL, Kremer LC, Hudson MM, Constine LS, Bardi E, Boekhout A, Borgmann-Staudt A, Brown MC, Cohn R, Dirksen U, Giwercman A, Ishiguro H, Jahnukainen K, Kenney LB, Loonen JJ, Meacham L, Neggers S, Nussey S, Petersen C, Shnorhavorian M, van den Heuvel-Eibrink MM, van Santen HM, Wallace WHB, Green DM. Recommendations for gonadotoxicity surveillance in male childhood, adolescent, and young adult cancer survivors: a report from the International Late Effects of Childhood Cancer Guideline Harmonization Group in collaboration with the PanCareSurFup Consortium. Lancet Oncol 2017; 18:e75-e90. [PMID: 28214419 DOI: 10.1016/s1470-2045(17)30026-8] [Citation(s) in RCA: 107] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2016] [Revised: 10/04/2016] [Accepted: 10/17/2016] [Indexed: 11/28/2022]
Abstract
Treatment with chemotherapy, radiotherapy, or surgery that involves reproductive organs can cause impaired spermatogenesis, testosterone deficiency, and physical sexual dysfunction in male pubertal, adolescent, and young adult cancer survivors. Guidelines for surveillance and management of potential adverse effects could improve cancer survivors' health and quality of life. Surveillance recommendations vary considerably, causing uncertainty about optimum screening practices. This clinical practice guideline recommended by the International Late Effects of Childhood Cancer Guideline Harmonization Group in collaboration with the PanCareSurFup Consortium, developed using evidence-based methodology, critically synthesises surveillance recommendations for gonadotoxicity in male childhood, adolescent, and young adult (CAYA) cancer survivors. The recommendations were developed by an international multidisciplinary panel including 25 experts in relevant medical specialties, using a consistent and transparent process. Recommendations were graded according to the strength of underlying evidence and potential benefit gained by early detection and appropriate management. The aim of the recommendations is to enhance evidence-based care for male CAYA cancer survivors. The guidelines reveal the paucity of high-quality evidence, highlighting the need for further targeted research.
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Affiliation(s)
- Roderick Skinner
- Department of Paediatric and Adolescent Haematology/Oncology and Children's Haemopoietic Stem Cell Transplant Unit, Great North Children's Hospital and Northern Institute of Cancer Research, Newcastle University, Newcastle upon Tyne, UK.
| | - Renee L Mulder
- Department of Pediatric Oncology, Emma Children's Hospital, Academic Medical Center, Amsterdam, Netherlands
| | - Leontien C Kremer
- Department of Pediatric Oncology, Emma Children's Hospital, Academic Medical Center, Amsterdam, Netherlands
| | - Melissa M Hudson
- Department of Oncology, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Louis S Constine
- Departments of Radiation Oncology and Pediatrics, University of Rochester Medical Center, Rochester, NY, USA
| | - Edit Bardi
- 2nd Department of Pediatrics, Semmeilweis University, Budapest, Hungary; Hungary and Johannes Kepler Universitätsklinikum, Linz, Austria
| | - Annelies Boekhout
- Department of Medical Oncology, Netherlands Cancer Institute/Antoni van Leeuwenhoek, Amsterdam, Netherlands
| | - Anja Borgmann-Staudt
- Department of Paediatric Haematology, Oncology and Haemopoietic Stem Cell Transplantation, Charité-Universitätsmedizin, Berlin, Germany
| | - Morven C Brown
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Richard Cohn
- Kids Cancer Centre, Sydney Children's Hospital, Sydney and UNSW Medicine, Sydney, NSW, Australia
| | - Uta Dirksen
- Department of Paediatric Haematology and Oncology, University Hospital Muenster, Muenster, Germany
| | | | - Hiroyuki Ishiguro
- Department of Pediatrics, Tokai University School of Medicine, Isehara, Japan
| | - Kirsi Jahnukainen
- Division of Hematology-Oncology and Stem Cell Transplantation, Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Lisa B Kenney
- Department of Pediatric Oncology, Dana-Farber/Boston Children's Cancer and Blood Disorder Center, Harvard Medical School, Boston, MA, USA
| | - Jacqueline J Loonen
- Department of Hematology, Radboud University Medical Center, Nijmegen, Netherlands
| | - Lilian Meacham
- Department of Pediatrics, Division of Hematology/Oncology and Endocrinology, Emory University and Aflac Cancer Center of Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Sebastian Neggers
- Department of Medicine section Endocrinology, Erasmus University Medical Center Rotterdam and Pediatric Oncology, Sophia's Children's Hospital/Erasmus University Medical Center, Rotterdam, Netherlands
| | - Stephen Nussey
- Department of Endocrinology, St George's University of London, London, UK
| | - Cecilia Petersen
- Department of Pediatric Oncology, Karolinska University Hospital, Stockholm, Sweden
| | - Margarett Shnorhavorian
- Department of Urology, University of Washington, Division of Pediatric Urology, Seattle Children's Hospital, Seattle, WA, USA
| | | | - Hanneke M van Santen
- Department of Pediatric Endocrinology, Wilhelmina Kinderziekenhuis, Universitair Medisch Centrum Utrecht, Utrecht, Netherlands
| | | | - Daniel M Green
- Departments of Oncology and Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, TN, USA
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Leroy C, Cortet-Rudelli C, Desailloud R. [Endocrine consequences in young adult survivors of childhood cancer treatment]. ANNALES D'ENDOCRINOLOGIE 2016; 76:S29-38. [PMID: 26776287 DOI: 10.1016/s0003-4266(16)30005-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Endocrine complications (particularly gonadal, hypothalamic-pituitary and metabolic) of childhood cancer treatments are common in young adults. Gonadal damage may be the result of chemotherapy or radiotherapy. Fertility preservation must be systematically proposed before initiation of gonadotoxic treatment if only the child is eligible. Hypothalamic-pituitary deficiency is common after brain or total-body irradiation, the somatotropic axis is the most sensitive to irradiation. Pituitary deficiency screening must be repeated since this endocrine consequence can occur many years after treatment. Hormone replacement must be prudent particularly in case of treatment with growth hormone or steroids. Metabolic syndrome, diabetes and cardiovascular damage resulting from cancer treatments contribute to the increase of morbidity and mortality in this population and should be screened routinely even if the patient is asymptomatic. The multidisciplinary management of these adults must be organized and the role of the endocrinologist is now well established.
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Affiliation(s)
- C Leroy
- Service d'Endocrinologie, Diabétologie, Maladies Métaboliques, Hôpital Claude Huriez, CHRU de Lille, Rue Michel Polonovski, 59037 Lille cedex, France; Service d'Andrologie, Hôpital Calmette, CHRU de Lille, Boulevard du Professeur Jules Leclercq, 59037 Lille cedex, France; Service d'Endocrinologie et Diabétologie Pédiatrique, Hôpital Jeanne de Flandre, CHRU de Lille, avenue Eugène Avinée, 59037 Lille cedex, France; Université Lille 2, Faculté de Médecine, Lille, France.
| | - C Cortet-Rudelli
- Service d'Endocrinologie, Diabétologie, Maladies Métaboliques, Hôpital Claude Huriez, CHRU de Lille, Rue Michel Polonovski, 59037 Lille cedex, France; Université Lille 2, Faculté de Médecine, Lille, France
| | - R Desailloud
- Service d'Endocrinologie, Diabétologie et Nutrition, CHRU d'Amiens, UPJV, Hôpital Sud, Avenue René Laennec 80054 Amiens cedex 1, France; Université de Picardie Jules Verne, Faculté de Médecine, Amiens, France
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Schneidewind L, Neumann T, Burchardt M, Krüger W. Urological Complications and BK Virus-Associated Diseases Under Allogenic Stem Cell Transplantation. Urol Int 2016; 97:434-439. [PMID: 27007784 DOI: 10.1159/000445124] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Accepted: 02/29/2016] [Indexed: 11/19/2022]
Abstract
Every year 50,000 patients receive a stem cell transplantation worldwide, but there is lack of data pertaining to urological complications. METHODS We performed a retrospective analysis of all adult patients undergoing their first allogenic stem cell transplantation from January 2011 to June 2013 in our institution. Statistical tests performed were Pearson's correlation, chi-square testing and logistic regression using SPSS 22.0. RESULTS We identified 39 patients (22 males, 17 females). Twenty four patients (61.5%) had a urological complication. Most frequent urologic complications were bacterial urinary tract infection (n = 13; 33.3%), acute renal failure (n = 6; 15.4%) and BK virus-associated haemorrhagic cystitis (n = 5; 12.8%). BK viruria was detected in 12 patients (30.8%). We observed an association of creatinine increase (about 20 µmol/l at time of onset of BK viruria) with BK viruria (Pearson's correlation 0.64; p = 0.01), and BK viruria is significantly linked to acute renal failure (Pearson's correlation 0.35; p = 0.029). In univariate regression, BK viruria is significantly linked to urological complication (p = 0.025). CONCLUSIONS We suggest that BK virus infection during stem cell transplantation can lead to BK virus associated nephropathy, which is so far only known from patients after kidney transplantation.
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Affiliation(s)
- Laila Schneidewind
- Department of Urology, University Medicine Greifswald, Greifswald, Germany
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12
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Gonadal status in long-term male survivors of childhood cancer. J Cancer Res Clin Oncol 2016; 142:1127-32. [DOI: 10.1007/s00432-016-2124-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Accepted: 01/25/2016] [Indexed: 10/22/2022]
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Gunnes MW, Lie RT, Bjørge T, Ghaderi S, Ruud E, Syse A, Moster D. Reproduction and marriage among male survivors of cancer in childhood, adolescence and young adulthood: a national cohort study. Br J Cancer 2016; 114:348-56. [PMID: 26794280 PMCID: PMC4742584 DOI: 10.1038/bjc.2015.455] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2015] [Revised: 11/24/2015] [Accepted: 12/04/2015] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Increased survival after cancer in young age has made long-term follow-up studies of high external validity important. In this national cohort study, we explored the impact of cancer in young age on reproduction and marital status in male survivors. METHODS Hazard ratios (HRs) and relative risks (RRs) of reproductive and marital outcomes were studied for male survivors of cancer in young age (<25 years) and cancer-free male comparisons, born during 1965-1985, by linking compulsory national registries in Norway. RESULTS Male cancer survivors (n=2687) had reduced paternity (HR: 0.72, 95% confidence interval (CI): 0.68-0.76). This was most apparent in survivors of testicular cancer, brain tumours, lymphoma, leukemia and bone tumours, and when diagnosed with cancer before 15 years of age. Male cancer survivors were more likely to avail of assisted reproduction (RR: 3.32, 95% CI: 2.68-4.11). There was no increased risk of perinatal death, congenital malformations, being small for gestational age, of low birth weight or preterm birth in their first offspring. Male cancer survivors were less likely to marry (HR: 0.93, 95% CI: 0.86-1.00), in particular brain tumour survivors. CONCLUSIONS In this national cohort study, we demonstrated reduced paternity and increased use of assisted reproduction among male cancer survivors, but no adverse outcome for their first offspring at birth.
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Affiliation(s)
- M W Gunnes
- Department of Global Public Health and Primary Care, University of Bergen, Postboks 7804, Bergen 5018, Norway
- Department of Pediatrics, Haukeland University Hospital, Bergen 5021, Norway
| | - R T Lie
- Department of Global Public Health and Primary Care, University of Bergen, Postboks 7804, Bergen 5018, Norway
- Norwegian Institute of Public Health, Bergen 5018, Norway
| | - T Bjørge
- Department of Global Public Health and Primary Care, University of Bergen, Postboks 7804, Bergen 5018, Norway
- Cancer Registry of Norway, Oslo 0304, Norway
| | - S Ghaderi
- Norwegian Institute of Public Health, Bergen 5018, Norway
| | - E Ruud
- Department of Pediatric Medicine, Oslo University Hospital, Oslo 0424, Norway
| | - A Syse
- Department of Research, Statistics Norway, Oslo 0033, Norway
| | - D Moster
- Department of Global Public Health and Primary Care, University of Bergen, Postboks 7804, Bergen 5018, Norway
- Department of Pediatrics, Haukeland University Hospital, Bergen 5021, Norway
- Norwegian Institute of Public Health, Bergen 5018, Norway
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Zhou ES, Nekhlyudov L, Bober SL. The primary health care physician and the cancer patient: tips and strategies for managing sexual health. Transl Androl Urol 2016; 4:218-31. [PMID: 26816826 PMCID: PMC4708119 DOI: 10.3978/j.issn.2223-4683.2014.11.07] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
There is a large and growing population of long-term cancer survivors. Primary care physicians (PCPs) are playing an increasingly greater role in the care of these patients across the continuum of cancer survivorship. In this role, PCPs are faced with the responsibility of managing a range of medical and psychosocial late effects of cancer treatment. In particular, the sexual side effects of treatment which are common and have significant impact on quality of life for the cancer survivor, often go unaddressed. This is an area of clinical care and research that has received increasing attention, highlighted by the presentation of this special issue on Cancer and Sexual Health. The aims of this review are 3-fold. First, we seek to overview common presentations of sexual dysfunction related to major cancer diagnoses in order to give the PCP a sense of the medical issues that the survivor may present with. Barriers to communication about sexual health issues between patient/PCPs in order are also described in order to emphasize the importance of PCPs initiating this important conversation. Next, we provide strategies and resources to help guide the PCP in the management of sexual dysfunction in cancer survivors. Finally, we discuss case examples of survivorship sexual health issues and highlight the role that a PCP can play in each of these case examples.
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Affiliation(s)
- Eric S Zhou
- 1 Dana-Farber Cancer Institute, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA ; 2 Harvard Vanguard Medical Associates, Boston, Massachusetts, USA
| | - Larissa Nekhlyudov
- 1 Dana-Farber Cancer Institute, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA ; 2 Harvard Vanguard Medical Associates, Boston, Massachusetts, USA
| | - Sharon L Bober
- 1 Dana-Farber Cancer Institute, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA ; 2 Harvard Vanguard Medical Associates, Boston, Massachusetts, USA
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Antal Z, Sklar CA. Gonadal Function and Fertility Among Survivors of Childhood Cancer. Endocrinol Metab Clin North Am 2015; 44:739-49. [PMID: 26568489 DOI: 10.1016/j.ecl.2015.08.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Reproductive health and fertility are of great importance to the increasing number of survivors of childhood cancer, approximately 70% of whom are estimated to be over 20 years old. This article reviews the various treatment exposures that have been associated with makers of gonadal injury and decreased fertility in childhood cancer survivors. Identifying risk factors that decrease fertility is essential in proper counseling and timely referral for interventions that may allow for future fertility in high-risk populations.
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Affiliation(s)
- Zoltan Antal
- Department of Pediatric Endocrinology, New York Presbyterian Hospital, Weill Cornell Medical College, 505 East 70 Street, New York, NY 10021, USA; Department of Pediatrics, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
| | - Charles A Sklar
- Department of Pediatrics, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA.
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Kurkure P, Prasad M, Dhamankar V, Bakshi G. Very small embryonic-like stem cells (VSELs) detected in azoospermic testicular biopsies of adult survivors of childhood cancer. Reprod Biol Endocrinol 2015; 13:122. [PMID: 26553338 PMCID: PMC4640406 DOI: 10.1186/s12958-015-0121-1] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Accepted: 11/02/2015] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Infertility is a known side-effect of oncotherapy in cancer survivors, and often compromises the quality of life. The present study was undertaken to detect very small embryonic-like stem cells (VSELs) in testicular biopsies from young adult survivors of childhood cancer who had azoospermia. VSELs have been earlier reported in human and mouse testes. They resist busulphan treatment in mice and potentially restore spermatogenesis when the somatic niche is restored by transplanting Sertoli or mesenchymal cells. VSELs also have the potential to differentiate into sperm in vitro. METHODS The study had clearance from Institutional review board (IRB). Seven azoospermic survivors of childhood cancer were included in the study after obtaining their informed consent. Semen analysis was done to confirm azoospermia prior to inclusion in the study. Testicular biopsies were performed at the Uro-oncology Unit of the hospital and then used for various studies to detect VSELs. RESULTS Hematoxylin and Eosin stained tubular sections confirmed azoospermia and smears revealed the presence of very small, spherical VSELs with high nucleo-cytoplasmic ratio, in addition to the Sertoli cells. Immuno-localization studies on testicular smears showed that the VSELs were CD133+/CD45-/LIN-, expressed nuclear OCT-4, STELLA and cell surface SSEA-4. Pluripotent transcripts Oct-4A, Nanog and Sox-2 were detected in azoospermic samples whereas marked reduction was observed in germ cell markers Oct-4 and Boule. CONCLUSIONS The present study demonstrates the presence of pluripotent VSELs in the testicular biopsy of azoospermic adult survivors of childhood cancer. It is likely that these persisting VSELs can restore spermatogenesis as demonstrated in mice studies. Therefore, pilot studies need to be undertaken using autologous mesenchymal cells with a hope to restore testicular function and fertility in cancer survivors. The results of this study assume a great significance in the current era, where cryopreservation of testicular tissue in young pre-pubertal boys for restoring spermatogenesis in adulthood is still in experimental stages.
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Affiliation(s)
- Purna Kurkure
- ACT Clinic, Department of Pediatric Oncology, Dr E Borges Road, Parel, Mumbai, 400012, India.
| | - Maya Prasad
- ACT Clinic, Department of Pediatric Oncology, Dr E Borges Road, Parel, Mumbai, 400012, India.
| | - Vandana Dhamankar
- ACT Clinic, Department of Pediatric Oncology, Dr E Borges Road, Parel, Mumbai, 400012, India.
| | - Ganesh Bakshi
- Division of Uro-oncology, Tata Memorial Hospital, Dr E Borges Road, Parel, Mumbai, 400012, India.
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Bone mineral density, thyroid function, and gonadal status in young adult survivors of childhood cancer. Contemp Oncol (Pozn) 2014; 19:142-7. [PMID: 26034393 PMCID: PMC4444441 DOI: 10.5114/wo.2014.44123] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2013] [Revised: 02/24/2014] [Accepted: 06/04/2014] [Indexed: 11/21/2022] Open
Abstract
Introduction During the last years, changes in the diagnosis and treatment have caused a significant increase of the number of young adults who experienced cancer in childhood. This enlarging population is affected by many health problems, including multiple hormone deficiencies and bone mineral deficits. This is the first polish study assessing bone mineral density and endocrine status in young adult cancer survivors. Material and methods A total of 76 long-term survivors treated for pediatric cancer were identified. The mean age at the time of study was 24.1 ±3.5 years. Bone mineral density and TSH, fT3, fT4, FSH, LH, estradiol and testosterone level were assessed for each patient. Results Nine subjects were diagnosed with subclinical hypothyroidism. We found higher level of TSH in the study group, in comparison with control group (p = 0.015). Eighteen patients had increased level of FSH. In the study group higher number of patients with high FSH level was found in comparison with the control group (p = 0.049). A low BMD was observed in 7 patients whereas mild BMD deficits were found in 19 participants. Conclusions In conclusion, our data show that young adult cancer survivors might experienced various hormonal problems including low bone mass, thyroid impairment and gonadal dysfunction. Some of the patients required treatment, but they were not diagnosed before this study. There is the lack of proper clinical assessment among adult childhood cancer survivors in Poland. Therefore, we demonstrated the need for a comprehensive plan for longitudinal follow-up for late effects in these population.
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Zarotsky V, Huang MY, Carman W, Morgentaler A, Singhal PK, Coffin D, Jones TH. Systematic literature review of the risk factors, comorbidities, and consequences of hypogonadism in men. Andrology 2014; 2:819-34. [PMID: 25269643 DOI: 10.1111/andr.274] [Citation(s) in RCA: 94] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Revised: 08/05/2014] [Accepted: 08/12/2014] [Indexed: 12/16/2022]
Affiliation(s)
- V. Zarotsky
- Product Value Strategy Consulting; Optum; Eden Prairie MN USA
| | - M.-Y. Huang
- Global Health Outcomes; Merck & Co. Inc.; West Point PA USA
- School of Pharmacy; Temple University; Philadelphia PA USA
| | - W. Carman
- Epidemiology; Optum; Ann Arbor MI USA
| | - A. Morgentaler
- Men's Health Boston; Brookline MA USA
- Harvard Medical School; Boston MA USA
| | - P. K. Singhal
- Global Health Outcomes; Merck & Co. Inc.; West Point PA USA
| | - D. Coffin
- Boolean Research Consulting; Westmount QC Canada
| | - T. H. Jones
- Robert Hague Centre for Diabetes and Endocrinology; Barnsley Hospital NHS Foundation Trust; Barnsley UK
- Department of Human Metabolism; School of Medicine and Biomedical Sciences; University of Sheffield; Sheffield UK
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Nickkholgh B, Mizrak SC, van Daalen SKM, Korver CM, Sadri-Ardekani H, Repping S, van Pelt AMM. Genetic and epigenetic stability of human spermatogonial stem cells during long-term culture. Fertil Steril 2014; 102:1700-7.e1. [PMID: 25256932 DOI: 10.1016/j.fertnstert.2014.08.022] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Revised: 08/08/2014] [Accepted: 08/14/2014] [Indexed: 12/25/2022]
Abstract
OBJECTIVE To determine the genetic and epigenetic stability of human spermatogonial stem cells (SSCs) during long-term culture. DESIGN Experimental basic science study. SETTING Reproductive biology laboratory. PATIENT(S) Cryopreserved human testicular tissue from two prostate cancer patients with normal spermatogenesis. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) Testicular cells before and 50 days after culturing were subjected to ITGA6 magnetic-activated cell sorting to enrich for SSCs. Individual spermatogonia were analyzed for aneuploidies with the use of single-cell 24-chromosome screening. Furthermore, the DNA methylation statuses of the paternally imprinted genes H19, H19-DMR (differentially methylated region), and MEG3 and the maternally imprinted genes KCNQ1OT1 and PEG3 were identified by means of bisulfite sequencing. RESULTS(S) Aneuploidy screening showed euploidy with no chromosomal abnormalities in all cultured and most noncultured spermatogonia from both patients. The methylation assays demonstrated demethylation of the paternally imprinted genes H19, H19-DMR, and MEG3 of 11%-28%, 43%-68%, and 18%-26%, respectively, and increased methylation of the maternally imprinted genes PEG 3 and KCNQ1OT of 13%-50% and 30%-38%, respectively, during culture. CONCLUSION(S) In the current culture system for human SSCs propagation, genomic stability is preserved, which is important for future clinical use. Whether the observed changes in methylation status have consequences on functionality of SSCs or health of offspring derived from transplanted SSCs requires further investigation.
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Affiliation(s)
- Bita Nickkholgh
- Center for Reproductive Medicine, Women's and Children's Hospital, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - S Canan Mizrak
- Center for Reproductive Medicine, Women's and Children's Hospital, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Saskia K M van Daalen
- Center for Reproductive Medicine, Women's and Children's Hospital, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Cindy M Korver
- Center for Reproductive Medicine, Women's and Children's Hospital, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Hooman Sadri-Ardekani
- Center for Reproductive Medicine, Women's and Children's Hospital, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Sjoerd Repping
- Center for Reproductive Medicine, Women's and Children's Hospital, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Ans M M van Pelt
- Center for Reproductive Medicine, Women's and Children's Hospital, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands.
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Systematic Literature Review of the Epidemiology of Nongenetic Forms of Hypogonadism in Adult Males. ACTA ACUST UNITED AC 2014. [DOI: 10.1155/2014/190347] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
This study summarizes the literature on the prevalence, incidence, and proportion of patients receiving treatment for male hypogonadism and a systematic literature search was performed for articles published in the last 20 years. Of the 97 studies identified, 96 examined the prevalence, 2 examined the incidence, and 4 examined the proportion of males with hypogonadism patients receiving treatment. Based on studies conducted in Europe and USA, the prevalence of hypogonadism in the general population ranged from 2.1% to 12.8% of middle-aged to older men, with an estimated incidence of 12 new cases per 1,000 person-years. Prevalence was higher among patients with comorbid conditions, such as type 2 diabetes mellitus and obesity. Approximately 10–12% of men with hypogonadism were receiving testosterone treatment. This literature review suggests that there is potentially a significant burden of hypogonadism in the general population. Burden seems to increase with age and in the presence of certain disease conditions. Data suggests that many hypogonadal men who may benefit from testosterone replacement are not receiving treatment. This may be the result of underdiagnosis of the disease, lack of awareness by patients or physicians, irregularities surrounding the diagnostic criteria, and deficiency of long-term safety studies.
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Bober SL, Zhou ES, Chen B, Manley PE, Kenney LB, Recklitis CJ. Sexual Function in Childhood Cancer Survivors: A Report from Project REACH. J Sex Med 2013; 10:2084-93. [DOI: 10.1111/jsm.12193] [Citation(s) in RCA: 70] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Sieswerda E, Mulder RL, van Dijk IWEM, van Dalen EC, Knijnenburg SL, van der Pal HJH, Mud MS, Heinen RC, Caron HN, Kremer LCM. The EKZ/AMC childhood cancer survivor cohort: methodology, clinical characteristics, and data availability. J Cancer Surviv 2013; 7:439-54. [PMID: 23625157 DOI: 10.1007/s11764-013-0283-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2013] [Accepted: 03/25/2013] [Indexed: 12/28/2022]
Abstract
PURPOSE Childhood cancer survivors are at high risk of late adverse effects of cancer treatment, but there are still many gaps in evidence about these late effects. We described the methodology, clinical characteristics, data availability, and outcomes of our cohort study of childhood cancer survivors. METHODS The Emma Children's Hospital/Academic Medical Center (EKZ/AMC) childhood cancer survivor cohort is an ongoing single-center cohort study of ≥5-year childhood cancer survivors, which started in 1996 simultaneously with regular structured medical outcome assessments at our outpatient clinic. RESULTS From 1966 to 2003, 3,183 eligible children received primary cancer treatment in the EKZ/AMC, of which 1,822 (57.2 %) survived ≥5 years since diagnosis. Follow-up time ranged from 5.0 to 42.5 years (median, 17.7). Baseline primary cancer treatment characteristics were complete for 1,781 (97.7 %) survivors, and 1,452 (79.7 %) survivors visited our outpatient clinic. Baseline characteristics of survivors who visited the clinic did not differ from those without follow-up. Within our cohort, 54 studies have been conducted studying a wide range of late treatment-related effects. CONCLUSIONS The EKZ/AMC childhood cancer survivor cohort provides a strong structure for ongoing research on the late effects of childhood cancer treatment and will continuously contribute in reducing evidence gaps concerning risks and risk groups within this vulnerable population. IMPLICATIONS FOR CANCER SURVIVORS Our large cohort study of childhood cancer survivors with complete baseline characteristics and unique, long-term medical follow-up decreases gaps in evidence about specific risks of late effects and high-risk groups, with the ultimate goal of improving the quality of care for childhood cancer survivors.
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Affiliation(s)
- E Sieswerda
- Department of Pediatric Oncology, Emma Children's Hospital/Academic Medical Center, Amsterdam, The Netherlands.
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van Dorp W, van der Geest IM, Laven JS, Hop WC, Neggers SJ, de Vries AC, Pieters R, van den Heuvel-Eibrink MM. Gonadal function recovery in very long-term male survivors of childhood cancer. Eur J Cancer 2013; 49:1280-6. [DOI: 10.1016/j.ejca.2012.12.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2012] [Revised: 11/29/2012] [Accepted: 12/09/2012] [Indexed: 10/27/2022]
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Spix C. Fertility in survivors of childhood cancer. DEUTSCHES ARZTEBLATT INTERNATIONAL 2012; 109:124-125. [PMID: 22427789 PMCID: PMC3301973 DOI: 10.3238/arztebl.2012.0124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Affiliation(s)
- Claudia Spix
- German Childhood Cancer Registry (GCCR) at the Institute of Medical Biostatistics, Epidemiology and Informatics, Mainz
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