Tumor cell contamination in ovarian tissue cryopreserved before gonadotoxic treatment: should we systematically exclude ovarian autograft in a cancer survivor?

摘要

Ovarian cryopreservation (OC) aims to preserve ovarian cortical tissue with primordial follicles before the start of gonadotoxic treatment, such as chemoradiotherapy, recognized as causing premature ovarian failure and sterility. On an ethical level, clear information concerning this risk and its potential prevention and treatment is obviously necessary, and this has in France been a legal obligation since 2006. The objective of OC is to transplant the ovarian cortex after remission to restore fertility. Six human live births have been described since 2004 after OC and autografting. OC is now widely performed by numerous teams, although the cases reported in the literature are still limited. In some cancers, the ovary may be contaminated by malignant cells with a potential risk of relapse if autografting is performed. In CML, leukemic cells are characterized by the chimeric Bcr-Abl transcript, which can be accurately quantified using the standardized RQ-PCR method. Treatment of CML relies on Imatinib, but allo-SCT remains the only definite curative treatment especially in younger patients.