在广泛的最小残留疾病筛查后,急性髓性白血病幸存者的冷冻保存卵巢组织自体移植:首次在欧洲报道活产。

IF 3.2 3区 医学 Q2 GENETICS & HEREDITY
Michelle Soares, Ingrid Segers, Michael De Brucker, Alessandra Camboni, Camille Hossay, Ileana Mateizel, Iebe De Quick, Ellen Van Moer, Dominik Selleslag, Steven Hellebaut, Marie-Madeleine Dolmans, Michel De Vos
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引用次数: 0

摘要

目的:我们报道了一例无菌急性髓系白血病患者在综合微量残留病(MRD)筛查后成功进行卵巢组织自体移植。方法:患者18岁,在同种异体干细胞移植前完全缓解时接受卵巢组织冷冻保存。卵巢早衰和怀孕的愿望使她在12年后要求移植冷冻保存的卵巢组织。在卵巢组织移植(OTT)前,对冻融活检标本进行广泛的MRD筛选,包括组织学、免疫组织化学、PCR和免疫缺陷小鼠6个月的异种移植。结果:卵巢解冻碎片的组织学和免疫组化(MPO、p53、CD4、CD45)未见恶性细胞污染。巢式RT-PCR (MLL::AF9)阴性,移植卵巢组织的小鼠6个月后无病变。再次分析异种移植组织(组织学、免疫组织化学和RT-PCR),未发现污染。腹腔镜移植术后患者卵巢功能恢复4个月。改良自然周期体外受精导致怀孕。29周时,患者发生胎膜早破,并在34.5周时生下了一个健康的男孩。移植后3年,患者仍无疾病。结论:对恶性细胞污染的担忧限制了白血病幸存者冷冻保存OTT。这是欧洲首次报道的急性髓性白血病幸存者在冷冻解冻OTT后活产。安全的OTT是通过在完全缓解期间取出卵巢组织并在移植前进行彻底筛查来实现的。接受全身照射的白血病幸存者的产科风险也应在尝试生育前的决策过程中进行彻底的讨论。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Cryopreserved ovarian tissue autotransplantation in an acute myeloid leukaemia survivor following extensive minimal residual disease screening: first reported live birth in Europe.

Purpose: We report successful autotransplantation of ovarian tissue in a sterile acute myeloid leukaemia survivor after comprehensive minimal residual disease (MRD) screening.

Methods: At age 18, the patient underwent ovarian tissue cryopreservation while in complete remission prior to allogeneic stem cell transplantation. Premature ovarian failure and the wish to conceive led her to request transplantation of her cryopreserved ovarian tissue 12 years later. Extensive MRD screening of frozen-thawed biopsy specimens, including histology, immunohistochemistry, PCR and 6-month xenotransplantation to immunodeficient mice, was conducted before ovarian tissue transplantation (OTT).

Results: Histology and immunohistochemistry (MPO, p53, CD4, CD45) of thawed ovarian fragments showed no malignant cell contamination. Nested RT-PCR (MLL::AF9) was negative and the mouse grafted with ovarian tissue showed no disease after 6 months. The xenografted tissue was analyzed again (histology, immunohistochemistry and RT-PCR) and showed no contamination. Laparoscopic transplantation to the patient restored ovarian function after 4 months. Modified natural cycle IVF resulted in pregnancy. At 29 weeks, the patient had preterm premature rupture of membranes and delivered a healthy boy at 34.5 weeks. Three years post-transplantation, the patient remains disease-free.

Conclusions: Concerns about malignant cell contamination limit cryopreserved OTT in leukemia survivors. This is the first reported European live birth in an acute myeloid leukemia survivor following frozen-thawed OTT. Safe OTT was achieved by retrieving ovarian tissue during complete remission and conducting thorough screening before transplantation. Obstetrical risks in leukemia survivors who had total body irradiation should also be thoroughly discussed during decision making before attempting motherhood.

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来源期刊
CiteScore
5.70
自引率
9.70%
发文量
286
审稿时长
1 months
期刊介绍: The Journal of Assisted Reproduction and Genetics publishes cellular, molecular, genetic, and epigenetic discoveries advancing our understanding of the biology and underlying mechanisms from gametogenesis to offspring health. Special emphasis is placed on the practice and evolution of assisted reproduction technologies (ARTs) with reference to the diagnosis and management of diseases affecting fertility. Our goal is to educate our readership in the translation of basic and clinical discoveries made from human or relevant animal models to the safe and efficacious practice of human ARTs. The scientific rigor and ethical standards embraced by the JARG editorial team ensures a broad international base of expertise guiding the marriage of contemporary clinical research paradigms with basic science discovery. JARG publishes original papers, minireviews, case reports, and opinion pieces often combined into special topic issues that will educate clinicians and scientists with interests in the mechanisms of human development that bear on the treatment of infertility and emerging innovations in human ARTs. The guiding principles of male and female reproductive health impacting pre- and post-conceptional viability and developmental potential are emphasized within the purview of human reproductive health in current and future generations of our species. The journal is published in cooperation with the American Society for Reproductive Medicine, an organization of more than 8,000 physicians, researchers, nurses, technicians and other professionals dedicated to advancing knowledge and expertise in reproductive biology.
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