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Gonadal shielding technique to preserve fertility in male pediatric patients treated with total body irradiation for stem cell transplantation

Bone Marrow Transplantation volume 51, pages 997–998 (2016)Cite this article

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Advances in hematopoetic stem cell transplantation (HSCTC) for the management of pediatric genetic disorders and malignancies have resulted in a growing population of adult survivors. With increased survival, current attention has now focused on improving treatment-related morbidities and quality of life for pediatric patients undergoing HSCTC. Infertility is one of the most common late effects and causes significant psychosocial problems for many pediatric patients, as well as for their family members.

In males, spermatogenesis can be impaired due to the toxic effects of radiation and cytotoxic chemotherapy. Determining the effects of specific types and doses of chemotherapy on spermatogenesis is difficult; however, substantial evidence now supports the view that alkylating agents and cisplatin cause the most risk for oligo- or azoospermia.1 The gonads are highly sensitive to radiation due to their constant turnover of early germ cells. A low dose of radiation (0.1–1.2 Gy) has been shown to impair spermatogenesis, and doses of >4 Gy may result in permanent damage to sperm production.2 Recovery of spermatogenesis depends both on total radiation dose and the dose per fraction. Leydig cells are susceptible to radiation-induced damage; however, their tolerance is higher (>20 Gy). Therefore, progression through puberty with normal testosterone levels is seen in survivors, who have developed secondary sexual characteristic despite having impaired spermatogenesis.3

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Acknowledgements

We thank Physics Department at the Winship Cancer Institute of Emory University for their help with preparation of the technique used in this study.

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Authors and Affiliations

  1. University of Vermont, College of Medicine, Burlington, VT, USA

    M Sayan

  2. Winship Cancer Institute, Emory University, Atlanta, GA, USA

    R J Cassidy, E E Butker, R H Nanda, L Krishnamurti, M K Khan & N Esiashvili

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  1. M Sayan
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  2. R J Cassidy
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Correspondence to N Esiashvili.

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Sayan, M., Cassidy, R., Butker, E. et al. Gonadal shielding technique to preserve fertility in male pediatric patients treated with total body irradiation for stem cell transplantation. Bone Marrow Transplant 51, 997–998 (2016). https://doi.org/10.1038/bmt.2016.25

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