Nickel Robert Sheppard, Maher Jacqueline Y, Hsieh Michael H, Davis Meghan F, Hsieh Matthew M, Pecker Lydia H
Children's National Hospital, Division of Hematology, Washington, DC 20001, USA.
Children's National Hospital, Division of Blood and Marrow Transplantation, Washington, DC 20001, USA.
J Clin Med. 2022 Apr 21;11(9):2318. doi: 10.3390/jcm11092318.
Curative therapy for sickle cell disease (SCD) currently requires gonadotoxic conditioning that can impair future fertility. Fertility outcomes after curative therapy are likely affected by pre-transplant ovarian reserve or semen analysis parameters that may already be abnormal from SCD-related damage or hydroxyurea treatment. Outcomes are also likely affected by the conditioning regimen. Conditioning with myeloablative busulfan and cyclophosphamide causes serious gonadotoxicity particularly among post-pubertal females. Reduced-intensity and non-myeloablative conditioning may be acutely less gonadotoxic, but more short and long-term fertility outcome data after these approaches is needed. Fertility preservation including oocyte/embryo, ovarian tissue, sperm, and experimental testicular tissue cryopreservation should be offered to patients with SCD pursing curative therapy. Regardless of HSCT outcome, longitudinal post-HSCT fertility care is required.
镰状细胞病（SCD）的治愈性疗法目前需要采用具有性腺毒性的预处理方案，这可能会损害未来的生育能力。治愈性疗法后的生育结果可能受到移植前卵巢储备或精液分析参数的影响，这些参数可能已因SCD相关损害或羟基脲治疗而异常。结果也可能受到预处理方案的影响。采用白消安和环磷酰胺进行清髓性预处理会导致严重的性腺毒性，尤其是在青春期后的女性中。降低强度和非清髓性预处理可能在急性期性腺毒性较小，但需要更多关于这些方法后的短期和长期生育结果的数据。对于寻求治愈性疗法的SCD患者，应提供生育力保存措施，包括卵母细胞/胚胎、卵巢组织、精子和实验性睾丸组织冷冻保存。无论造血干细胞移植（HSCT）的结果如何，HSCT后都需要进行长期的生育护理。
