Paternity Wishes in Young Long-Term Survivors After Allogeneic Hematopoietic Stem Cell Transplantation. A Study of the Late Effects Working Party of the EBMT

Abstract 2002

Gonadal dysfunction with the absence of sperm production is a common non-malignant late effect after allogeneic hematopoietic stem cell transplantation (HSCT). We previously reported in a large retrospective multicenter study of 224 male survivors after HSCT data on sperm recovery and the risk factors associated with infertility. However, so far there is no data regarding the wish to become a father after HSCT. We report here on paternity and wishes for paternity in this same cohort. Out of 224 patients, 195 (87%) were transplanted for a malignant hematological disease, 155 (64%) were transplanted before the year 2000. TBI (*7.5Gy) was part of the conditioning in 146 (66%) patients; 44 (20%) were conditioned with Busulfan based regimen and 31 (14%) without TBI and without Busulfan. During the follow-up 142/222 (64%) recipients presented acute graft versus host disease (aGVHD) and 134/220 (61%) chronic GVHD. Before HSCT, 50/211 (24%) patients with a median age at HSCT of 36 (22–59) years, had at least one child (total number of children 84). After HSCT, 29/211 (14%) patients with a median age at HSCT of 21 (2–55) years, became father (total number of children: 44). The median time interval between HSCT and the birth of the first child was 7.2 (1–21.6) years. Ninety percent of the patients who had a child before HSCT were older than 25 years at HSCT and only 28% of the patients without a child were older than 25 at HSCT. Six out of 30 patients with a child before HSCT (20%) wished to father a child after HSCT, whereas 90/115 (78%) of childless patients before HSCT had wishes for paternity afterwards. Hence, patients who had a child before HSCT were significantly older at HSCT (p<0.0001) and had fewer wishes to conceive a child after HSCT (p<0.00001). Twenty four percent of the patients had cryopreserved sperms before HSCT regardless of fatherhood before HSCT (5/31 (16%) with children before HSCT; 30/119 (25%) without children, p= 0.211). Among the patients who fathered a child after HSCT, 8 were normozoospermic and conceived in a natural way, 3 were oligozoospermic (natural conception 1; cryopreserved sperms 1; unknown 1), 4 were severely oligozoospermic (natural conception 2; unknown 2) and 10 had azoospermia (all of them conceived with an assisted technique). Furthermore 4 recipients adopted a child; none of them had children before HSCT. These patients were not considered for analysis in the group who fathered a child after HSCT.