title: Ongoing graft-versus-host disease is a risk factor for azoospermia after allogeneic hematopoietic stem cell transplantation: a survey of the Late Effects Working Party of the European Group for Blood and Marrow Transplantation.
abstract: The aim of this study was to assess the degree of spermatogenesis defects in sperm analysis in long-term male survivors after allogeneic hematopoietic stem cell transplantation in order to identify the risk factors related to potential infertility after hematopoietic stem cell transplantation and to provide data on longitudinal sperm recovery after hematopoietic stem cell transplantation. Here, the Late Effects Working Party of the European Group for Blood and Marrow Transplantation reports data of sperm analysis from 224 males who underwent hematopoietic stem cell transplantation. Median time between transplantation and sperm analysis was 63 months (8-275 months). At last sperm analysis, presence of any degree of spermatozoa was reported in 70 (31%) and complete azoospermia in 154 (69%) patients. In multivariate analysis, being conditioned with total body irradiation (RR 7.1; 95% CI: 3.4-14.8) and age over 25 years at transplantation (RR 2.4; 95% CI: 1.09-5.2) were significantly associated with higher risk for azoospermia. In patients not conditioned with total body irradiation, ongoing chronic graft-versus-host disease is the main adverse factor for sperm recovery (RR of 3.11; 95% CI: 1.02-9.47; P=0.045). Already established risk factors, such as total body irradiation and age older than 25 years at hematopoietic stem cell transplantation, were seen to be the most relevant adverse risk factor for sperm production after hematopoietic stem cell transplantation. Furthermore, for the first time, ongoing graft-versus-host disease has been shown to be the most relevant adverse factor for sperm recovery, particularly in patients conditioned without total body irradiation. We also introduce a useful scoring system to predict the probability of male long-term survivors' azoospermia.
authors.affiliation: University Hospital of Basel, Basel, Switzerland. RovoA@uhbs.ch
authors.forename: Alicia
authors.initials: A
authors.lastname: Rovó
authors.forename: Mahmoud
authors.initials: M
authors.lastname: Aljurf
authors.forename: Sandra
authors.initials: S
authors.lastname: Chiodi
authors.forename: Simonetta
authors.initials: S
authors.lastname: Spinelli
authors.forename: Nina
authors.initials: N
authors.lastname: Salooja
authors.forename: Gülsan
authors.initials: G
authors.lastname: Sucak
authors.forename: Ann
authors.initials: A
authors.lastname: Hunter
authors.forename: Tan Swee
authors.initials: TS
authors.lastname: Kim
authors.forename: Gérard
authors.initials: G
authors.lastname: Socié
authors.forename: Maria Teresa
authors.initials: MT
authors.lastname: van Lint
authors.forename: Jakob R
authors.initials: JR
authors.lastname: Passweg
authors.forename: Mutlu
authors.initials: M
authors.lastname: Arat
authors.forename: Manuela
authors.initials: M
authors.lastname: Badoglio
authors.forename: André
authors.initials: A
authors.lastname: Tichelli
mesh_terms: D000328:Adult; D053713:Azoospermia / Q000209:etiology*; D006086:Graft vs Host Disease / Q000150:complications* / Q000209:etiology; D006306:Health Surveys; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D055101:Semen Analysis; D017741:Survivors; D019172:Transplantation Conditioning / Q000009:adverse effects; D014184:Transplantation, Homologous; D055815:Young Adult