Conception and congenital abnormalities after chemotherapy of acute myelogenous leukaemia in two men

Fertility preservation in men: a contemporary overview and a look toward emerging technologies

Cancer and oncologic therapies can have significant adverse effects on male reproductive potential, leaving many men permanently infertile. Fertility preservation has emerged as a key survivorship issue over the past 20 years, and numerous professional societies have published guidelines calling for fertility preservation to become a routine component of oncologic care. Most males with cancer are able to produce a semen specimen for fertility preservation, but numerous other methods of sperm procurement are available for patients who cannot provide a sufficient sample. Despite these options, fertility preservation will remain a challenge for prepubertal boys and men without sperm production. For these patients, experimental and investigational approaches offer the hope that one day they will translate to the clinical arena, offering additional pathways for successful fertility preservation care.

Risks of genetic damage in offspring conceived using spermatozoa produced during chemotherapy or radiotherapy

BACKGROUND

Men who have just started cytotoxic therapy for cancer are uncertain and concerned about whether spermatozoa collected or pregnancies occurring during therapy might be transmitting genetic damage to offspring. There are no comprehensive guidelines on the risks of different doses of the various cytotoxic, and usually genotoxic, antineoplastic agents.

OBJECTIVES

To develop a schema showing the risks of mutagenic damage when spermatozoa, exposed to various genotoxic agents during spermatogenesis, are collected or used to produce a pregnancy.

MATERIALS AND METHODS

A comprehensive literature review was performed updating the data on genetic and epigenetic effects of genotoxic agents on animal and human spermatozoa exposed during spermatogenic development.

RESULTS

Relevant data on human spermatozoa and offspring are extremely limited, but there are extensive genetic studies in experimental animals that define sensitivities for specific drugs and times. The animal data were extrapolated to humans based on the stage when the cells were exposed and the relative kinetics of spermatogenesis and were consistent with the limited human data. In humans, alkylating agents and radiation should already induce a high risk of mutations in spermatozoa produced within 1 or 2 weeks after initiation of therapy. Topoisomerase II inhibitors and possibly microtubule inhibitors produce the greatest risk at weeks 5-7 of therapy. Nucleoside analogs, antimetabolites, and bleomycin exert their mutagenic effects on spermatozoa collected at 7-10 weeks of therapy.

DISCUSSION AND CONCLUSIONS

A schema showing the time from initiation of therapy at which specific antineoplastic agents can cause significant levels of genetic damage in conceptuses and live offspring was developed. The estimates and methods for computing the level of such risk from an individual patient's treatment regimen will enable patients and counselors to make informed decisions on the use of spermatozoa or continuation of a pregnancy.

Parenteral iron compounds: potent oxidants but mainstays of anemia management in chronic renal disease

Ferric iron (Fe)-carbohydrate complexes are widely used for treating Fe deficiency in patients who are unable to meet their Fe requirements with oral supplements. Intravenous Fe generally is well tolerated and effective in correcting Fe-deficient states. However, the complexing of Fe to carbohydrate polymers does not block its potent pro-oxidant effects; systemic free radical generation and, possibly, tissue damage may result. The purpose of this review is to (1) underscore the capacity of currently used parenteral Fe formulations to induce oxidative stress, (2) compare the severity of these oxidant reactions with those that result from unshielded Fe salts and with each other, and (3) speculate as to the potential of these agents to induce acute renal cell injury and augment systemic inflammatory responses. The experimental data that are reviewed should not be extrapolated to the clinical setting or be used for clinical decision making. Rather, it is hoped that the information provided herein may have utility for clinical hypothesis generation and, hence, future clinical studies. By so doing, a better understanding of Fe's potential protean effects on patients with renal disease may result.

Antimitotic drugs in the male rat. Behavioral abnormalities in the second generation

The second generation descended from rats treated either with cyclophosphamide alone or with both cyclophosphamide and vinblastine were investigated. As in the first generation, the offspring were evaluated for mean litter size, sex ratio, frequency of gross external malformations and, within the first 4 months of life, growth and mortality. When they reached adulthood, between 12 and 16 weeks of age, the offspring were also tested for spontaneous activity and learning capacity. At birth, the progeny of the treated grandfathers did not show malformations or any other obvious disorder. However, when compared with the control population, the experimental animals showed significantly decreased success rates in a learning task, whatever the learning performance of their parents. Furthermore, decreased spontaneous activity was observed in the male subjects from unsuccessful parents. The similarities between the anomalies found in the first and the second generations argue for the induction of mutations by antimitotic drugs. This hypothesis and the subtle differences between generations and between sexes are discussed.

Antimitotic drugs (cyclophosphamide and vinblastine) in the male rat. Deaths and behavioral abnormalities in the offspring

The spermatogenesis and the offspring of male rats treated either with cyclophosphamide alone, or with both cyclophosphamide and vinblastine were investigated. The offspring were evaluated for the mean number of pups per litter, sex ratio, the frequency of apparent external malformations and, within the first 4 months of life, growth and mortality. When they reached adulthood and were between 12 and 16 weeks of age, the offspring were also examined for spontaneous activity and learning capacity. Treatment with cyclophosphamide or cyclophosphamide and vinblastine resulted in a decrease in the number of both primary spermatocytes and spermatids; the effect, however, lasted longer for the combined drug regimen. At birth, the animals sired by the treated males did not show any apparent malformations. However, compared with the control population the mortality rate of the offspring was significantly higher within the first 40 days of life; at adult age, the proportion of animals that failed in the learning ability test was significantly increased and those that did succeed showed impaired learning capacity. The difference, however, was significant only in the male offspring. Finally, the offspring's spontaneous activity was significantly decreased. No difference was found in mortality or behavior between the animals born of the cyclophosphamide or cyclophosphamide plus vinblastine-treated males. The behavioral disorders shown in the adult offspring confirm the existence of a long-term risk of paternal origin. This risk, essentially functional and independent of any morphologic pathology, should be taken into account in the context of environmental genotoxicity.

Cyclophosphamide in the male rat: behavioral effects in the adult offspring

Cyclophosphamide in a daily dose of 10 mg/kg was injected intraperitoneally in male Wistar rats for 15 days. Two rats each time were killed for testis examination at regular intervals within 100 days following treatment (over 2 spermatogenetic cycles). One hundred days after the end of the treatment, the other rats, whose spermatogenesis had recovered in the meantime, were mated with 3-month-old females. Offspring were evaluated in regard to the mean number per litter, sex ratio, frequency of gross external malformations, growth pattern, mortality in the first 4 months of life and reproductive ability at 6 months of age. Offspring behavior was also examined between 10 and 14 weeks of age. They were evaluated for spontaneous activity and emotionality with an open field test and for learning ability with an avoidance conditioning test. Cyclophosphamide induced a significant decrease in the number of primary spermatocytes and spermatozoa. Only learning ability was altered in the offspring from the treated males, for the animals which succeeded in the avoidance conditioning test did not learn as rapidly as the controls. However, the difference was significant only in the males. Behavioral abnormalities and the possible genetic factors involved are related to the particular concept of 'physioteratogenesis'.

Annual representative meeting: presidential address

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Investigation into the mutagenic activity of azathioprine (Imuran) in different test systems

The chromosome-damaging effect of azathioprine (Imuran) was investigated in the micronucleus test with mice and rats, in the pertussis-stimulated lymphocyte metaphase test with rabbits, and in children on azathioprine therapy. In the micronucleus test, there was a dose-dependent increase in the number of cells with micronuclei. The dose was given twice in 24 h, i.p., 25, 50 and 100 mg/kg body weight for mice, and 50, 100 and 200 mg/kg for rats. In the lymphocyte test, a dose of 5 and 20 mg azathioprine per kg body weight was given orally to rabbits on three successive days after pertussis injection. Compared with treatment in the control group these treatments induced a significantly increased number of cells with chromosomal abnormalities. These results were confirmed in lymphocyte cultures of children on long-term azathioprine therapy after kidney transplantation, where an increase in the number of structural chromosomal abnormalities was observed.

Conception of normal child during chemotherapy of acute lymphoblastic leukaemia in the father

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