Criopreservación de corteza ovárica en pacientes jóvenes con cáncer e indicación de tratamiento gonadotóxico
Resumen
Introducción: el aumento de la tasa de curación de pacientes jóvenes con cáncer hace imprescindible planear estrategias que puedan disminuir las secuelas de los tratamientos. Las repercusiones reproductivas son de las más importantes.
Objetivo: presentar la instrumentación del Programa de Preservación de la Función Ovárica Frente al Cáncer así como publicar el protocolo específico de criopreservación de tejido ovárico aplicado.
Material y método: se tomaron las primeras 15 pacientes en las que, cumpliendo los criterios de inclusión, se optó por la estrategia de criopreservar tejido ovárico previo al inicio de la quimioterapia. En 12 casos se les realizó la criopreservación de un ovario con conservación del otro, con biopsia ovárica bilateral como único procedimiento. En los tres casos restantes se asoció la traslocación heterotópica del otro ovario. Se describe el protocolo de criopreservación utilizado.
Resultados: se realizó el procedimiento en 15 pacientes con distintos tipos de cáncer que requerían tratamiento altamente gonadotóxico. El procedimiento se realizó con éxito en todas.
Discusión y conclusiones: la conjunción del esfuerzo multidisciplinario y multiinstitucional ha puesto en marcha este programa, que instrumenta una técnica aún en desarrollo. Se trata de un procedimiento a implementar dentro de un protocolo específico. Constituye, no obstante y por ahora, la única oportunidad para un grupo seleccionado de pacientes de preservar la función ovárica hormonal y eventualmente reproductiva.
Citas
(2) Chiarelli A, Marrett L, Darlington G. Early menopause and infertility in females after treatment for childhood cancer diagnosed in 1964-1988 in Ontario, Canada. Am J Epidemiol 1999; 150:245-54.
(3) Wallace W, Thomson AB, Saran F, Kelsey T. Predicting age of ovarian failure after radiation to a field that includes the ovaries. Int J Radiat Oncol Biol Phys 2005; 62(3): 738-44.
(4) Wallace W, Thomson A, Kelsey T. The radiosensitivity of the human oocyte. Hum Reprod 2003; 18(1): 117-21.
(5) Byrne J, Fears T, Gail M, Pee D, Connelly R, Austin D, et al. Early menopause in long-term survivors of cancer during adolescence. Am J Obstet Gynecol 1992; 166: 788-93.
(6) Coppola F, Nader J. Visión neuroendócrina de la menopausia. Arch Ginecol Obstet 2002; 40(3): 129-33.
(7) Faddy M, Gosden R, Gougeon A, Richardson S, Nelson J. Accelerated disappearance of ovarian follicles in mid-life: implications for forecasting menopause. Hum Reprod 1992; 7(10): 1342-6.
(8) Larsen E, Müller J, Rechnitzer C, Schmiegelow K, Andersen A. Diminished ovarian reserve in female childhood cancer survivors with regular menstrual cycles and basal FSH <10 IU/l. Hum Reprod 2003; 18: 417-22.
(9) Clark S, Redford J, Crowther D, Swindell R, Shale S. Gonadal function following chemotherapy for Hodgkin’s disease: a comparative study of MVPP and a seven-drug hybrid regimen. J Clin Oncol 1995; 13: 134-9.
(10) Meirow D. Reproduction post-chemotherapy in young cancer patients. Mol Cell Endocrinol 2000; 169: 123-31.
(11) Lovelock J. The haemolysis of human red blood-cells by freezing and thawing. Biochem Biophys Acta 1953; 10: 414-26.
(12) Arav A, Zeron Y, Ocheretny A. A new device and method for vitrification increases the cooling rate and allows successful cryopreservation of bovine oocytes. Theriogenology 2000; 53(1): 248.
(13) Mazur P. Kinetics of water loss from cells at subzero temperatures and the likelihood of intracellular freezing. J Gen Physiol 1963; 47: 347-69.
(14) Mazur P. Freezing of living cells: mechanisms and implications. Am J Physiol 1984; 247(3 Pt1): C125-42.
(15) Fahy GM. The relevance of cryoprotectant "toxicity" to cryobilogy. Cryobilogy 1986; 23: 1-13.
(16) Karow A. Biological effects of cryoprotectant perfusion, delivery and removal to nonfroze organ. In: Pegg D, Karow A Jr. ed. The biophysics of organ preservation. NewYork: Plenum, 1987: 25-41.
(17) Anchordoguy T, Cecchini C, Croswe J. Insights into the cryoprotective mechanism of dimethyl sulfoxide for phospholid bilayers. Cryobiology 1991; 28: 467-73.
(18) McGann L. Differing actions of penetrating and nonpenetrating cryoprotective agents. Cryobiology 1978; 15: 382-90.
(19) Fahy G, MacFarlane D, Angell C, Meryman H. Vitrification as an approach to cryopreservation. Cryobiology 1984: 407-26.
(20) Parkes A, Smith A. Regeneration of rat ovarian tissue grafted after exposure to low temperatures. Proc R Soc Lond B Biol Sci 1953; 140: 455-67.
(21) Parkes A. Grafting of mouse ovarian tissue after freezing and thawing. J Endocrinol 1956; 14(3): 30-1.
(22) Parkes A. Viability of ovarian tissue after freezing. Proc R Soc Lond B Biol Sci 1957; 147: 520-8.
(23) Deanesly R. Immature rat ovaries grafted after freezing and thawing. J Endocrinol 1954; 11: 197-200.
(24) Deanesly R, Parkes A. Delayed development of grafts from frozen ovarian tissue. J Endocrinol 1956; 14: 35-6.
(25) Newton H. The cryopreservation of ovarian tissue as a strategy for preserving the fertility of cancer patients. Hum Reprod Update 1998; 4(3): 237-47.
(26) Hovatta O, Silye R, Krausz T, Abrir R, Margara R, Trew G, et al. Cryopreservation of human ovarian tissue using dime-thyulsulphoxide and propanediol-sucrose as cryporotectans. Hum Reprod 1996; 45: 898-906.
(27) Oktay K, Nugent D, Newton H, Salha O, Chatterjee P, Gosden R. Isolation and characterisation of primordial follicles from fresh and cryopreserved human ovarian tissue. Fertil Steril 1997; 67: 481-6.
(28) Donnez J, Dolmans M, Demylle D, Jadoul P, Pirard C, Squifflet J, et al. Livebirth after orthotopic transplantation of cryopreserved ovarian tissue. Lancet 2004; 364(9443): 1405-10.
(29) FIGO Committee for the Ethical Aspects of Human Reproduction and Women’s Health. Ethical considerations and recommendations on oocyte and ovarian cryopreservation. Int J Gynaecol Obstet 2006; 92(3): 335-6.
(30) Multidisciplinary Working Group convened by the British Fertility Society. A strategy for fertility services for survivors of childhood cancer. Hum Fertil (Camb) 2003; 6: A1-A39.
(31) Callejo J, Salvador C, Miralles A, Vilaseca S, Lailla JM, Balasch J. Long-term ovarian function evaluation after autografting by implantation with fresh and frozen-thawed human ovarian tissue. J Clin Endocrinol Metab 2001; 86(9): 4489-94.
(32) Schmidt K, Byskov A, Nyboe Andersen A, Mueller J, Yding Andersen C. Density and distribution of primordial follicles in single pieces of cortex from 21 patients and in individual pieces of cortex from three entire human ovaries. Human Reprod 2003; 18(6):1158-64.
(33) Oktay K, Gosden R, Schwarz R. Ovarian function after autologus transplantation of frozen-banked human ovarian tissue. ASRM 1999. Toronto, Ontario, Canada.
(34) Oktay K, Karlikaya G. Ovarian function after transplantation of frozen, banked autologous ovarian tissue. N Engl J Med 2000; 342: 1919.
(35) Radford J, Liebermann B, Brison D, Smith A, Critchlow J, Russell S, et al. Orthotopic reimplantation of cryopreserved ovarian cortical strips after high-dose chemotherapy for Hodgkin’s lymphoma. Lancet 2001; 357: 1172-5.
(36) Kim S, Hwang I, Lee H. Heterotopic autotransplantation of cryobanked human ovarian tissue as a strategy to restore ovarian function. Fertil Steril 2004; 82(4): 930-2.
(37) Oktay K, Buyuk E, Veeck L, Zaninivic N, Xu K, Takeuchi T, et al. Embryo development after heterotopic transplantation of cryopreserved ovarian tissue. Lancet 2004; 363: 837-40.
(38) Kirsten L, Schmidt T, Yding Andersen C, Starup J, Loft A, Grete Byskov A, et al. Orthotopic autotransplantation of cryopreserved ovarian tissue to a woman cured of cancer-follicular growth, steroid production and oocyte retrieval Reproductive Bio Medicine Online 2004; 8(4): 448-53.
(39) Meirow D, Levron J, Eldar-Geva T, Hardan I, Fridman E, Zalel Y, et al. Pregnancy after Transplantation of Cryopreserved Ovarian Tissue in a Patient with Ovarian Failure after Chemotherapy. BMJ 2005; 353(3): 318-21.
(40) Wallace W, Pritchard J. Livebirth after cryopreserved ovarian tissue autotransplantation. Lancet 2004; 364: 2093-4.
(41) Oktay K, Tilly J. Livebirth after cryopreserved ovarian tissue autotransplantation. Lancet 2004; 364: 2091-2.
(42) Oktay K. Spontaneous conceptions and live birth after heterotopic ovarian transplantation: is there a germline stem cell connection? Hum Reprod 2006; 21: 1345-8.
(43) Johnson J, Canning J, Kaneko T, Pru J, Tilly J. Germline stem cells and follicular renewal in the postnatal mammalian ovary. Nature 2004; 428: 145-50.
(44) Johnson J, Bagley J, Skaznik-Wikiel M, Lee H, Adams G, Niikura Y, et al. Oocyte generation in adult mammalian ovaries by putative germ cells in bone marrow and peripheral blood. Cell 2005; 122: 303-15.
(45) Oktay K, Sonmezer M. Ovarian tissue banking for cancer patients: fertility preservation, not just ovarian cryopreservation. Hum Reprod 2004; 19(3): 477-80.
(46) Abir R, Nitke S, Ben-Haroush A, Fisch B. In vitro maturation of human primordial ovarian follicles: clinical significance, progress in mammals, and methods for growth evaluation. Histol Histopathol 2006; 21(8): 887-98.