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Rostami T, Mohammadifard MA, Ansari S, Kiumarsi A, Maleki N, Kasaeian A, Aghamahdi F, Rad S, Ghavamzadeh A. Indicators of male fertility potential in adult patients with beta-thalassemia major: a comparative study between patients undergone allogeneic stem cell transplantation and transfusion-dependent patients. FERTILITY RESEARCH AND PRACTICE 2020; 6:4. [PMID: 32161655 PMCID: PMC7060570 DOI: 10.1186/s40738-020-00071-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/26/2019] [Accepted: 02/05/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND Allogeneic hematopoietic stem cell transplantation (HSCT) remains the only potentially curative treatment for thalassemia major (TM). Infertility and its indicators have been assessed in transfusion dependent TM men, but in this study, we sought to compare the fertility indicators of TM patients after HSCT with those in patients treated conventionally. The possible influential factors on reproductive capacity in TM patients undergone allogeneic HSCT were also evaluated. PATIENTS AND METHODS In this cross-sectional study, we compared the gonadal hormones level, testicular volume, Tanner stage and sperm analysis in transfusion-dependent thalassemia major (TDTM) patients who survived matched sibling HSCT (n = 43) with patients conventionally treated by transfusion and iron chelation (n = 52). RESULTS The patients' age range was between 16 to 41 years. Tanner stage 4-5 was seen in 39 patients (41%). The prevalence of hypogonadism in our patients was 32.63% but its frequency was not significantly different between the two groups (p = 0.35). Azospermia, oligospermia, astenospermia, teratospermia and even having dry and low volume ejaculate were all significantly more frequent in the post-transplant patients compared to TDTM group. In the post-HSCT group, neither patients' age at transplantation nor the conditioning regimen used in their transplant process did significantly affect their hormonal status and sperm parameters. Chronic graft versus host disease (GVHD) occurred in 14 (40%) patients. No significant difference was observed between the grade of chronic GVHD and hypogonadism (P = 0.853). CONCLUSIONS Thalassemia patients undergone allogeneic HSCT have lower fertility potential, mainly in sperm parameters compared with patients treated with blood transfusion and chelation. This information is important for thalassemic patients considering HSCT.
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Affiliation(s)
- Tahereh Rostami
- Hematology, Oncology and Stem Cell Transplantation Research Center, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Amir Mohammadifard
- Hematology, Oncology and Stem Cell Transplantation Research Center, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Shahla Ansari
- Department of Hematology-Oncology, Ali Asghar Children’s Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Azadeh Kiumarsi
- Hematology, Oncology and Stem Cell Transplantation Research Center, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Nasrollah Maleki
- Hematology, Oncology and Stem Cell Transplantation Research Center, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Amir Kasaeian
- Hematology, Oncology and Stem Cell Transplantation Research Center, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Aghamahdi
- Non-communicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, Iran
| | - Soroush Rad
- Hematology, Oncology and Stem Cell Transplantation Research Center, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Ardeshir Ghavamzadeh
- Hematology, Oncology and Stem Cell Transplantation Research Center, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
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Shenoy S, Walters MC, Ngwube A, Soni S, Jacobsohn D, Chaudhury S, Grimley M, Chan K, Haight A, Kasow KA, Parikh S, Andreansky M, Connelly J, Delgado D, Godder K, Hale G, Nieder M, Pulsipher MA, Trachtenberg F, Neufeld E, Kwiatkowski JL, Thompson AA. Unrelated Donor Transplantation in Children with Thalassemia using Reduced-Intensity Conditioning: The URTH Trial. Biol Blood Marrow Transplant 2018; 24:1216-1222. [PMID: 29374585 PMCID: PMC5993578 DOI: 10.1016/j.bbmt.2018.01.023] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2017] [Accepted: 01/18/2018] [Indexed: 01/19/2023]
Abstract
Allogeneic hematopoietic stem cell transplantation (HSCT) can cure transfusion-dependent thalassemia (TDT). In a multicenter trial we investigated the efficacy of reduced-intensity conditioning (RIC) before unrelated donor (URD) HSCT in children with TDT. Thirty-three children, ages 1 to 17 years, received bone marrow (BM) or umbilical cord blood (UCB) allografts. Median time to neutrophil engraftment was 13 days (range, 10 to 25) and 24 days (range, 18 to 49) and platelet engraftment 23 days (range, 12 to 46) and 50 days (range, 31 to 234) after BM and UCB allografts, respectively. With a median follow-up of 58 months (range, 7 to 79), overall and thalassemia-free survival was 82% (95% CI, .64% to .92%) and 79% (95% CI, .6% to .9%), respectively. The cumulative incidence of grades II to IV acute graft-versus-host disease (GVHD) after BM and UCB allografts was 24% and 44%; the 2-year cumulative incidence of chronic extensive GVHD was 29% and 21%, respectively; 71% of BM and 91% of UCB recipients discontinued systemic immunosuppression by 2 years. Six patients who had Pesaro risk class 2 (n = 5) and class 3 (n = 1) died of GVHD (n = 3), viral pneumonitis (n = 2) and pulmonary hemorrhage (n = 1). Outcomes after this RIC compared favorably with URD HSCT outcomes for TDT and supported engraftment in 32 of 33 patients. Efforts to reduce GVHD and infectious complications are being pursued further.
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Affiliation(s)
- Shalini Shenoy
- Department of Pediatrics, St. Louis Children's Hospital, Washington University, St. Louis, Missouri.
| | - Mark C Walters
- Department of Pediatrics, UCSF Benioff Children's Hospital, Oakland, California
| | - Alex Ngwube
- Department of Pediatrics, Phoenix Children's Hospital, Phoenix, Arizona
| | - Sandeep Soni
- Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio; Department of Pediatrics, Lucile Packard Children's Hospital, Stanford University, Palo Alto, California
| | - David Jacobsohn
- Department of Pediatrics, Children's National Medical Center, Washington, DC
| | - Sonali Chaudhury
- Department of Pediatrics, Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University, Chicago, Illinois
| | - Michael Grimley
- Department of Pediatrics, Texas Transplant Institute, San Antonio, Texas
| | - Kawah Chan
- Department of Pediatrics, Texas Transplant Institute, San Antonio, Texas
| | - Ann Haight
- Department of Pediatrics, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, Georgia
| | - Kimberley A Kasow
- Department of Pediatrics, University of North Carolina, Chapel Hill, North Carolina
| | - Suhag Parikh
- Department of Pediatrics, Duke University Medical Center, Durham, North Carolina
| | - Martin Andreansky
- Department of Pediatrics, University of Miami, Holtz Children's Hospital, Miami, Florida
| | - Jim Connelly
- Department of Pediatrics, University of Michigan, Ann Arbor, Michigan
| | - David Delgado
- Department of Pediatrics, Riley Children's Hospital, Indianapolis, Indiana
| | - Kamar Godder
- Department of Pediatrics, Nicklaus Children's Hospital, Miami, Florida
| | - Gregory Hale
- Department of Pediatrics, Johns Hopkins All Children's Hospital, St. Petersburg, Florida
| | - Michael Nieder
- Department of Pediatrics, Johns Hopkins All Children's Hospital, St. Petersburg, Florida
| | - Michael A Pulsipher
- Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, California
| | - Felicia Trachtenberg
- Department of Pediatrics, New England Research Institutes, Boston, Massachusetts
| | - Ellis Neufeld
- Department of Pediatrics, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Janet L Kwiatkowski
- Department of Pediatrics, Children's Hospital of Philadelphia, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Alexis A Thompson
- Department of Pediatrics, Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University, Chicago, Illinois
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Rahal I, Galambrun C, Bertrand Y, Garnier N, Paillard C, Frange P, Pondarré C, Dalle JH, de Latour RP, Michallet M, Steschenko D, Moshous D, Lutz P, Stephan JL, Rohrlich PS, Yakoub-Agha I, Bernaudin F, Piguet C, Aladjidi N, Badens C, Berger C, Socié G, Dumesnil C, Castex MP, Poirée M, Lambilliotte A, Thomas C, Simon P, Auquier P, Michel G, Loundou A, Agouti I, Thuret I. Late effects after hematopoietic stem cell transplantation for β-thalassemia major: the French national experience. Haematologica 2018; 103:1143-1149. [PMID: 29599204 PMCID: PMC6029533 DOI: 10.3324/haematol.2017.183467] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Accepted: 03/23/2018] [Indexed: 12/12/2022] Open
Abstract
In this retrospective study, we evaluate long-term complications in nearly all β-thalassemia-major patients who successfully received allogeneic hematopoietic stem cell transplantation in France. Ninety-nine patients were analyzed with a median age of 5.9 years at transplantation. The median duration of clinical follow up was 12 years. All conditioning regimens were myeloablative, most were based on busulfan combined with cyclophosphamide, and more than 90% of patients underwent a transplant from a matched sibling donor. After transplantation, 11% of patients developed thyroid dysfunction, 5% diabetes, and 2% heart failure. Hypogonadism was present in 56% of females and 14% of males. Female patients who went on to normal puberty after transplant were significantly younger at transplantation than those who experienced delayed puberty (median age 2.5 vs. 8.7 years). Fertility was preserved in 9 of 27 females aged 20 years or older and 2 other patients became pregnant following oocyte donation. In addition to patient’s age and higher serum ferritin levels at transplantation, time elapsed since transplant was significantly associated with decreased height growth in multivariate analysis. Weight growth increased after transplantation particularly in females, 36% of adults being overweight at last evaluation. A comprehensive long-term monitoring, especially of endocrine late effects, is required after hematopoietic stem cell transplantation for thalassemia.
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Affiliation(s)
- Ilhem Rahal
- Service d'Hémato-Oncologie Pédiatrique, Hôpital d'Enfant de la Timone, Assistance Publique des Hôpitaux de Marseille, France
| | - Claire Galambrun
- Service d'Hémato-Oncologie Pédiatrique, Hôpital d'Enfant de la Timone, Assistance Publique des Hôpitaux de Marseille, France
| | - Yves Bertrand
- Service d'Hématologie et Immunologie Pédiatrique, Institut d'Hématologie et d'Oncologie Pédiatrique, Lyon, France
| | - Nathalie Garnier
- Service d'Hématologie et Immunologie Pédiatrique, Institut d'Hématologie et d'Oncologie Pédiatrique, Lyon, France
| | - Catherine Paillard
- Service d'Hémato-Oncologie Pédiatrique, CHU de Strasbourg - Hôpital de Hautepierre, France
| | - Pierre Frange
- Service d'Immunologie Hématologie Pédiatrique, CHU Necker-Enfants Malades, Assistance Publique Hôpitaux de Paris, France
| | - Corinne Pondarré
- Service de Pédiatrie, Centre de Référence de la Drépanocytose, Centre Hospitalier Intercommunal de Créteil (CHIC), France
| | - Jean Hugues Dalle
- Service d'Immunologie Hématologie, Hôpital Robert Debré, Assistance Publique Hôpitaux de Paris, France
| | - Regis Peffault de Latour
- Service d'Hémato-Oncologie - Greffe, Hôpital Saint Louis, Assistance Publique Hôpitaux de Paris, France
| | | | - Dominique Steschenko
- Service d'Hémato-Oncologie Pédiatrique, CHRU Nancy, Hôpitaux de Brabois, Vandoeuvre-lès-Nancy, France
| | - Despina Moshous
- Service d'Immunologie Hématologie Pédiatrique, CHU Necker-Enfants Malades, Assistance Publique Hôpitaux de Paris, France
| | - Patrick Lutz
- Service d'Hémato-Oncologie Pédiatrique, CHU de Strasbourg - Hôpital de Hautepierre, France
| | - Jean Louis Stephan
- Service d'Immuno-Hématologie et Oncologie Pédiatrique, CHU de Saint-Étienne, Saint-Priest-en-Jarez, France
| | | | | | - Françoise Bernaudin
- Service de Pédiatrie, Centre de Référence de la Drépanocytose, Centre Hospitalier Intercommunal de Créteil (CHIC), France
| | - Christophe Piguet
- Service d'Hémato-Oncologie Pédiatrique, Hôpital de la Mère et de l'Enfant, CHU de Limoges, France
| | - Nathalie Aladjidi
- Service de Pédiatrie Médicale, Groupe Hospitalier Pellegrin Enfants, Bordeaux, France
| | - Catherine Badens
- Centre de Référence Thalassémie, Hôpital d'Enfant de la Timone, Assistance Publique des Hôpitaux Marseille, France
| | - Claire Berger
- Service d'Immuno-Hématologie et Oncologie Pédiatrique, CHU de Saint-Étienne, Saint-Priest-en-Jarez, France
| | - Gérard Socié
- Service d'Hémato-Oncologie - Greffe, Hôpital Saint Louis, Assistance Publique Hôpitaux de Paris, France
| | - Cécile Dumesnil
- Service d'Immuno-Hématologie et Oncologie Pédiatrique, CHU-Hôpitaux de Rouen, France
| | - Marie Pierre Castex
- Service d'Hémato-Oncologie Pédiatrique, Hôpital Des Enfants, CHU de Toulouse, France
| | - Marilyne Poirée
- Service d'Hémato-Oncologie Pédiatrique, Hôpital l'Archet 2, CHU de Nice, France
| | - Anne Lambilliotte
- Service de Maladies du Sang, CHRU Lille-Hôpital Claude Huriez, France
| | - Caroline Thomas
- Service d'Hématologie Pédiatrique, Hôpital Enfant-Adolescent, CHU Nantes, France
| | - Pauline Simon
- Service d'Hémato-Oncologie Pédiatrie, CHRU Jean Minjoz, Besançon, France
| | - Pascal Auquier
- Service de Santé Publique, Assistance Publique des Hôpitaux Marseille et Université Aix-Marseille, France
| | - Gérard Michel
- Service d'Hémato-Oncologie Pédiatrique, Hôpital d'Enfant de la Timone, Assistance Publique des Hôpitaux de Marseille, France
| | - Anderson Loundou
- Service de Santé Publique, Assistance Publique des Hôpitaux Marseille et Université Aix-Marseille, France
| | - Imane Agouti
- Centre de Référence Thalassémie, Hôpital d'Enfant de la Timone, Assistance Publique des Hôpitaux Marseille, France
| | - Isabelle Thuret
- Service d'Hémato-Oncologie Pédiatrique, Hôpital d'Enfant de la Timone, Assistance Publique des Hôpitaux de Marseille, France .,Centre de Référence Thalassémie, Hôpital d'Enfant de la Timone, Assistance Publique des Hôpitaux Marseille, France
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