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Reimplantation of cryopreserved ovarian tissue from patients with acute lymphoblastic leukemia is potentially unsafe

Marie-Madeleine Dolmans, Cristina Marinescu, Pascale Saussoy, Anne Van Langendonckt, Christiani Amorim, Jacques Donnez

Abstract

Ovarian tissue cryopreservation is currently proposed to young cancer patients to preserve their fertility before radio-chemotherapy. The potential risk is that the tissue might harbor malignant cells that could induce disease recurrence. We therefore decided to evaluate the presence of leukemic cells in cryopreserved ovarian tissue from 18 leukemic patients: 6 with chronic myeloid leukemia (CML) and 12 with acute lymphoblastic leukemia (ALL). In each case, histology, RT-qPCR and long-term (6 months) xenografting to immunodeficient mice were used. Histology did not identify any malignant cells in the ovarian tissue. By RT-qPCR, 2 out of 6 CML patients were positive for BCR-ABL in their ovarian tissue. Among the 12 ALL patients, 7 of the 10 with available molecular markers showed positive leukemic markers in their ovarian tissue (translocations or rearrangement genes). Four mice grafted with ovarian tissue from ALL patients developed intraperitoneal leukemic masses. In conclusion, this study demonstrates, by RT-qPCR, ovarian contamination by malignant cells in acute as well as chronic leukemia, while histology fails to do so. Moreover, chemotherapy before ovarian cryopreservation does not exclude malignant contamination. Finally, reimplantation of cryopreserved ovarian tissue from ALL and CML patients puts them at risk of disease recurrence.

  • Submitted January 25, 2010.
  • Accepted June 7, 2010.