Adult testicular volume predicts spermatogenetic recovery after allogeneic HSCT in childhood and adolescence.
BACKGROUND
Testicular dysfunction and infertility are of major concern in long-term survivors after allogeneic hematopoietic stem cell transplantation (HSCT). This study assesses predictive factors for very long-term testicular recovery after allogeneic HSCT in childhood and adolescence.


METHODS
Testicular volume, sperm production and long-term need of testosterone substitution were evaluated among 106 male survivors transplanted at Huddinge and Helsinki University Hospitals from 1978 through 2000, at a mean age of 8 ± 4.6 years (range 1-17). A mean ± SD of 13 ± 4.8 years (range 4-28) had elapsed since their HSCT and the mean age of the participants was 22 ± 6.0 years (range 12-42). An adult testicular volume was recorded in 74 patients at a mean age of 19 ± 3.3 years (range 14-36).


RESULTS
Recipients conditioned with busulfan-based regimens or regimens containing only cyclophosphamide had significantly larger adult testicular volumes (mean volume 18 ml and 16 ml vs. 9 ml, P < 0.00001, respectively) and lower serum levels of FSH (mean 9 IU and 5 IU vs. 19 IU, P < 0.01 and 0.001, respectively) compared to those conditioned with total body irradiation (TBI). Multivariate analysis demonstrated that a non-leukemia diagnosis (P < 0.01) and adult testicular volume ≥ 15 ml (P < 0.03) positively impacted spermatogenetic recovery.


CONCLUSIONS
A larger adult testicular volume, normal serum levels of FSH and spermatozoa detected in a majority of seminal fluids after busulfan-based or cyclophosphamide conditionings suggest very long-term recovery of spermatogenesis after chemotherapy-based regimens. A simple measurement of adult testicular volume may help predict spermatogenetic potential among pediatric HSCT survivors.
Mari
M
Wilhelmsson
Anu
A
Vatanen
Birgit
B
Borgström
Britt
B
Gustafsson
Mervi
M
Taskinen
Ulla M
UM
Saarinen-Pihkala
Jacek
J
Winiarski
Kirsi
K
Jahnukainen
D000293:Adolescent; D064591:Allografts; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000009:adverse effects; D002066:Busulfan / Q000008:administration & dosage / Q000009:adverse effects; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D016371:Cranial Irradiation / Q000009:adverse effects; D003520:Cyclophosphamide / Q000008:administration & dosage / Q000009:adverse effects; D005640:Follicle Stimulating Hormone / Q000097:blood; D018380:Hematopoietic Stem Cell Transplantation; D020249:Hormone Replacement Therapy; D006801:Humans; D007223:Infant; D007248:Infertility, Male / Q000097:blood / Q000209:etiology* / Q000473:pathology / Q000517:prevention & control; D008297:Male; D019653:Myeloablative Agonists / Q000008:administration & dosage / Q000009:adverse effects; D009369:Neoplasms / Q000150:complications* / Q000188:drug therapy / Q000601:surgery; D009929:Organ Size; D011183:Postoperative Complications / Q000097:blood / Q000209:etiology / Q000473:pathology; D011627:Puberty; D011832:Radiation Injuries / Q000097:blood / Q000209:etiology / Q000473:pathology; D055101:Semen Analysis; D013091:Spermatogenesis; D017741:Survivors; D013737:Testis / Q000187:drug effects / Q000473:pathology* / Q000528:radiation effects; D013739:Testosterone / Q000627:therapeutic use; D019172:Transplantation Conditioning / Q000009:adverse effects; D014916:Whole-Body Irradiation / Q000009:adverse effects
D019653:Myeloablative Agonists; D013739:Testosterone; D003520:Cyclophosphamide; D005640:Follicle Stimulating Hormone; D002066:Busulfan