Rostami Tahereh, Mohammadifard Mohammad Amir, Ansari Shahla, Kiumarsi Azadeh, Maleki Nasrollah, Kasaeian Amir, Aghamahdi Fatemeh, Rad Soroush, Ghavamzadeh Ardeshir
1Hematology, Oncology and Stem Cell Transplantation Research Center, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran.
2Department of Hematology-Oncology, Ali Asghar Children's Hospital, Iran University of Medical Sciences, Tehran, Iran.
Fertil Res Pract. 2020 Mar 7;6:4. doi: 10.1186/s40738-020-00071-6. eCollection 2020.
Allogeneic hematopoietic stem cell transplantation (HSCT) remains the only potentially curative treatment for thalassemia major (TM). Infertility and its indicators have been assessed in transfusion dependent TM men, but in this study, we sought to compare the fertility indicators of TM patients after HSCT with those in patients treated conventionally. The possible influential factors on reproductive capacity in TM patients undergone allogeneic HSCT were also evaluated.
In this cross-sectional study, we compared the gonadal hormones level, testicular volume, Tanner stage and sperm analysis in transfusion-dependent thalassemia major (TDTM) patients who survived matched sibling HSCT ( = 43) with patients conventionally treated by transfusion and iron chelation ( = 52).
The patients' age range was between 16 to 41 years. Tanner stage 4-5 was seen in 39 patients (41%). The prevalence of hypogonadism in our patients was 32.63% but its frequency was not significantly different between the two groups ( = 0.35). Azospermia, oligospermia, astenospermia, teratospermia and even having dry and low volume ejaculate were all significantly more frequent in the post-transplant patients compared to TDTM group. In the post-HSCT group, neither patients' age at transplantation nor the conditioning regimen used in their transplant process did significantly affect their hormonal status and sperm parameters. Chronic graft versus host disease (GVHD) occurred in 14 (40%) patients. No significant difference was observed between the grade of chronic GVHD and hypogonadism ( = 0.853).
Thalassemia patients undergone allogeneic HSCT have lower fertility potential, mainly in sperm parameters compared with patients treated with blood transfusion and chelation. This information is important for thalassemic patients considering HSCT.
异基因造血干细胞移植（HSCT）仍然是重型地中海贫血（TM）唯一可能治愈的治疗方法。输血依赖型TM男性患者的不育情况及其指标已得到评估，但在本研究中，我们试图比较HSCT后TM患者与传统治疗患者的生育指标。我们还评估了接受异基因HSCT的TM患者生殖能力的可能影响因素。
在这项横断面研究中，我们比较了接受匹配同胞HSCT后存活的输血依赖型重型地中海贫血（TDTM）患者（n = 43）与接受输血和铁螯合传统治疗的患者（n = 52）的性腺激素水平、睾丸体积、 Tanner分期和精液分析结果。
患者年龄范围为16至41岁。39例患者（41%）处于Tanner 4-5期。我们患者中性腺功能减退的患病率为32.63%，但两组之间的发生率无显著差异（P = 0.35）。与TDTM组相比，移植后患者中无精子症、少精子症、弱精子症、畸形精子症，甚至精液量少且质地稀薄的发生率均显著更高。在HSCT后组中，患者移植时的年龄和移植过程中使用的预处理方案均未显著影响其激素状态和精子参数。14例（40%）患者发生慢性移植物抗宿主病（GVHD）。慢性GVHD的分级与性腺功能减退之间未观察到显著差异（P = 0.853）。
与接受输血和螯合治疗的患者相比，接受异基因HSCT的地中海贫血患者生育潜力较低，主要体现在精子参数方面。这一信息对于考虑进行HSCT的地中海贫血患者很重要。
