Clinical Scorecard: Effects of Hematopoietic Stem Cell Transplantation on Fertility in Patients with Benign and Malignant Hematologic and Non-Hematologic Conditions: A Systematic Review and Meta-Analysis

At a Glance

Key Highlights

• HSCT indications and procedures are increasing with improved 5-year survival rates up to 90% for some diseases.
• Pregnancy rates post-HSCT remain low (<5%) due to high risk of gonadal toxicity from conditioning regimens.
• Fertility preservation strategies vary by disease urgency, patient sex, and pubertal status, with options including cryopreservation of gametes and gonadal tissue.

Guideline-Based Recommendations

Diagnosis

• Assess baseline fertility status and risk of gonadal toxicity prior to HSCT.
• Use standardized definitions of clinically relevant gonadal toxicity for evaluation.

Management

• Provide pre-HSCT counseling on fertility preservation tailored to disease type and treatment urgency.
• Consider sperm freezing in males before induction chemotherapy in malignant diseases.
• Offer oocyte or ovarian tissue cryopreservation in benign diseases or when time allows before HSCT.
• Explore experimental cryopreservation options for prepubertal patients.

Monitoring & Follow-up

• Long-term follow-up of gonadal function post-HSCT to evaluate fertility outcomes.
• Use validated fertility parameters and clinical assessments during survivorship.

Risks

• High risk of primary ovarian insufficiency or testicular failure due to conditioning regimens.
• Complexity in fertility preservation especially in malignant diseases with urgent treatment timelines.
• Limited fertility preservation options for prepubertal patients.

Patient & Prescribing Data

Patients undergoing HSCT for hematologic and non-hematologic benign and malignant diseases

HSCT conditioning regimens carry significant gonadotoxic risk necessitating individualized fertility preservation planning before therapy initiation

Clinical Best Practices

• Implement multidisciplinary fertility counseling prior to HSCT initiation.
• Tailor fertility preservation strategies based on disease urgency, patient sex, and pubertal status.
• Use systematic assessment tools and quality scales (e.g., Newcastle-Ottawa Scale) to evaluate study data and patient risk.
• Maintain awareness of evolving fertility preservation techniques and experimental options for pediatric patients.

References

• FertiTOX Project
• PROSPERO Registration CRD42023486928