Optimizing treatment efficacy and fertility preservation in patients undergoing hematopoietic stem cell transplantation: A narrative review of ovarian shielding with total-body irradiation or treosulfan-based conditioning regimens.

IF 2.7 3区 医学 Q2 OBSTETRICS & GYNECOLOGY
Reproductive Medicine and Biology Pub Date : 2025-04-17 eCollection Date: 2025-01-01 DOI:10.1002/rmb2.12648
Yuji Tanaka, Tetsuro Hanada, Tsukuru Amano, Akimasa Takahashi, Mari Deguchi, Hiroyuki Yamanaka, Shunichiro Tsuji, Takashi Murakami
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引用次数: 0

Abstract

Background: Pediatric and adolescent/young adult (AYA) patients with hematologic malignancies often require hematopoietic stem cell transplantation (HSCT) using conditioning regimens that pose high risks for gonadal toxicity. Traditional protocols, including total body irradiation (TBI) and busulfan-based regimens, can impair fertility. This review explores the potential of gonadal shielding during TBI and treosulfan-based conditioning as strategies to optimize treatment efficacy while preserving fertility.

Methods: A PubMed search up to February 2025 was performed for English, peer-reviewed articles on hematologic malignancies, HSCT, shielding, and treosulfan. Studies on oncologic outcomes and fertility in pediatric and AYA patients were included.

Main findings: Ovarian shielding during myeloablative conditioning with TBI effectively reduces ovarian radiation exposure, resulting in improved menstrual recovery and hormone profiles. A treosulfan-based regimen demonstrated higher antitumor activity than a reduced-intensity busulfan-based regimen in randomized controlled trials. In a retrospective analysis, the treosulfan-based regimen exhibited lower gonadal toxicity than the busulfan-based regimen, although careful attention must be paid to dosing settings of the regimens.

Conclusion: Ovarian shielding during TBI and a treosulfan-based regimen hold the potential to preserve the reproductive capacity of patients undergoing HSCT. Future clinical studies that appropriately assess both oncological outcomes and fertility are needed to validate these findings.

在接受造血干细胞移植的患者中优化治疗效果和保留生育能力:用全身照射或treosulan为基础的调节方案对卵巢屏蔽的叙述性回顾。
背景:患有血液恶性肿瘤的儿童和青少年/青年(AYA)患者通常需要使用具有性腺毒性高风险的调节方案进行造血干细胞移植(HSCT)。传统的方案,包括全身照射(TBI)和基于布硫丹的方案,可能会损害生育能力。这篇综述探讨了创伤性脑损伤期间性腺屏蔽和基于曲硫丹的调节作为优化治疗效果同时保持生育能力的策略的潜力。方法:PubMed检索到2025年2月,对血液恶性肿瘤、HSCT、屏蔽和tresofan的英文同行评审文章进行检索。研究包括了儿科和AYA患者的肿瘤预后和生育能力。主要发现:在创伤性脑损伤的清髓调节过程中,卵巢屏蔽有效地减少了卵巢辐射暴露,从而改善了月经恢复和激素水平。在随机对照试验中,以曲硫丹为基础的方案显示出比低强度布硫丹为基础的方案更高的抗肿瘤活性。在一项回顾性分析中,以曲硫丹为基础的方案比以布硫丹为基础的方案显示出更低的性腺毒性,尽管必须仔细注意方案的剂量设置。结论:TBI期间的卵巢屏蔽和以曲硫丹为基础的治疗方案有可能保护接受HSCT患者的生殖能力。未来的临床研究需要适当地评估肿瘤预后和生育能力来验证这些发现。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
5.70
自引率
5.90%
发文量
53
审稿时长
20 weeks
期刊介绍: Reproductive Medicine and Biology (RMB) is the official English journal of the Japan Society for Reproductive Medicine, the Japan Society of Fertilization and Implantation, the Japan Society of Andrology, and publishes original research articles that report new findings or concepts in all aspects of reproductive phenomena in all kinds of mammals. Papers in any of the following fields will be considered: andrology, endocrinology, oncology, immunology, genetics, function of gonads and genital tracts, erectile dysfunction, gametogenesis, function of accessory sex organs, fertilization, embryogenesis, embryo manipulation, pregnancy, implantation, ontogenesis, infectious disease, contraception, etc.
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