Preservation of Fertility and of Reproduction Ability in Lymphoma Patients

Abstract

Aim: The aim of this article is to provide the health professionals with clear, novel and practical guidelines regarding management of fertility in patients with malignant hematological disorders, with special accent on lymphoma. Also, it aims at raising consciousness of all physicians administering chemotherapy, about the undesired effects of many chemotherapy regimens, on the reproductive ability, about available methods for preserving fertility and regarding many other issues in connection with fertility in patients treated for lymphoma. Materials and methods: Online internet databases and publications have been searched, and a systematic literature review has been performed, using the following keywords: fertility, chemotherapy as well as relevant keywords in connection to the subject. Results: Within the search, reports regarding smaller-sized groups, as well as in series of patients and case reports have been found, but relatively few large randomized studies or actual reports regarding the success rate and the influence of methods for fertility preservation in patients treated for Hodgkin's and Non-Hodgkin's lymphoma. We have managed in summarizing a large proportion of the research studies and transferring it into an integral multidisciplinary text, offering valid and applicable options for fertility preservation in patients treated for lymphoma. We use the term lymphoma in general, since the chemotherapy and radiotherapy approaches for Hodgkin's and for Non-Hodgkin's lymphomas are similar, rendering a major part of the fertility preservation guidelines appropriate for both entities. Recommendations: Hematologists should possess fundamental knowledge regarding the late complications of lymphoma treatment. Besides acknowledging the risk of secondary cancer development as well as of non-neoplastic cardiac and pulmonary complications, they should be prepared to raise the issue of infertility as an integral part of the treatment plan, since that is a complication of significant importance for patients treated with chemotherapy within their reproductive life period. Possible methods for preserving fertility should be presented and discussed, and patients should be referred promptly to a reproductive medicine specialist. Cryopreservation of both sperm and embryos are considered standard practice and are generally available, while other methods are still in investigational phase and performed in specialized centers under mandatory professional surveillance and expertise. Conclusion: It is recommended to utilize treatments that are with as little as possible gonadal toxicity, to consider a wide array of options for fertility preservation as soon as possible, and to practice a decision-making process most beneficial for the patient, based on the latest medical accomplishments and most novel prospects.