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Ann Oncol. 2019 Aug 16. pii: mdz284. doi: 10.1093/annonc/mdz284. [Epub ahead of print]

Preserving fertility in female patients with hematological malignancies: A multidisciplinary oncofertility approach.

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Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.
Kids Cancer Centre, Sydney Children's Hospital, Sydney, Australia.
Nelune Cancer Centre, Prince of Wales Hospital, Sydney, Australia.
School of Women's and Children's Health, University of New South Wales, Sydney, Australia.


Oncofertility is a new interdisciplinary field at the intersection of oncology and reproductive medicine that expands fertility options for young cancer patients. The most common forms of hematological malignancies that occur in girls and young women and therefore necessitate oncofertility care are acute lymphocytic leukemia (ALL), acute myeloid leukemia (AML), non-Hodgkin lymphoma (NHL), and Hodgkin lymphoma (HL). Aggressive gonadotoxic anticancer regimens including alkylating chemotherapy and total body irradiation (TBI) are used often in treating girls and young women with hematological malignancies. The risks of gonadotoxicity and subsequent iatrogenic premature ovarian insufficiency (POI) and fertility loss depend mainly on the type and stage of the disease, dose of anticancer therapy as well as the age of the patient at the beginning of treatment. To avoid or at least mitigate the devastating complications of anticancer therapy-induced gonadotoxicity, effective and comprehensive strategies that integrate different options for preserving and restoring fertility ranging from established to experimental strategies should be offered before, during and after chemotherapy or radiotherapy. A multidisciplinary approach that involves strong coordination and collaboration between hemato-oncologists, gynecologists, reproductive biologists, research scientists and patient navigators is essential to guarantee high standard of care.


Oncofertility; artificial ovary; fertility preservation; hematological malignancies; leukemia; lymphoma


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