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First pregnancy and live birth in Turkey following frozen-thawed ovarian tissue transplantation in a patient with acute lymphoblastic leukemia who underwent cord blood transplantation

Purpose To report the first live birth after frozen-thawed ovarian transplantation in Turkey and the second case for an acute lymphoblastic leukemia (ALL) survivor in the world. Methods A 19-year-old patient underwent ovarian tissue cryopreservation (OTC) before cord blood transplantation in 2010. S...

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Published in:Journal of assisted reproduction and genetics 2020-08, Vol.37 (8), p.2033-2043
Main Authors: Sonmezer, Murat, Ozkavukcu, Sinan, Sukur, Yavuz Emre, Kankaya, Duygu, Arslan, Onder
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Ozkavukcu, Sinan
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Kankaya, Duygu
Arslan, Onder
description Purpose To report the first live birth after frozen-thawed ovarian transplantation in Turkey and the second case for an acute lymphoblastic leukemia (ALL) survivor in the world. Methods A 19-year-old patient underwent ovarian tissue cryopreservation (OTC) before cord blood transplantation in 2010. She was diagnosed as ALL with a bone marrow biopsy revealing 90% blast ALL-L2 type, and karyotype analyses indicated reciprocal translocation at t(9;22)(q34;q11). The patient received the Berlin-Frankfurt-Munster (BFM) protocol, and complete remission was achieved before fertility preservation. Serum AMH level was measured as 1.5 ng/ml, and 12 antral follicles were counted on ultrasound. She was informed about fertility preservation options and decided to proceed with OTC, with her signed consent before cord blood transplantation in April 2011. Ovarian tissue transplantation (OTT) was performed in 2017 when the patient was menopausal with serum FSH levels > 100 IU/ml and estradiol
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Methods A 19-year-old patient underwent ovarian tissue cryopreservation (OTC) before cord blood transplantation in 2010. She was diagnosed as ALL with a bone marrow biopsy revealing 90% blast ALL-L2 type, and karyotype analyses indicated reciprocal translocation at t(9;22)(q34;q11). The patient received the Berlin-Frankfurt-Munster (BFM) protocol, and complete remission was achieved before fertility preservation. Serum AMH level was measured as 1.5 ng/ml, and 12 antral follicles were counted on ultrasound. She was informed about fertility preservation options and decided to proceed with OTC, with her signed consent before cord blood transplantation in April 2011. Ovarian tissue transplantation (OTT) was performed in 2017 when the patient was menopausal with serum FSH levels &gt; 100 IU/ml and estradiol &lt; 20 pg/ml and hematologically in molecular remission. Detailed molecular analysis, standard histology, and immunohistochemistry demonstrated that the thawed tissue is free of malignant cells. Results Six months following OTT, she had spontaneous menstruation with serum FSH 11 IU/ml and estradiol 53 pg/ml. Two consecutive IVF cycles yielded three top-quality embryos. Following three embryo transfer cycles, one fresh and two frozen, a healthy term live birth was achieved. Frozen-thawed-transplanted tissues were extracted during caesarean delivery upon the patient’s request after a total period of 25 months in vivo, and histopathological evaluation revealed that the tissue was free of leukemic infiltration. Conclusion The authors report the first pregnancy and live birth in Turkey and the second live birth in the world following transplantation of frozen-thawed ovarian tissue in a leukemia survivor. As the transplanted tissues were removed during caesarean delivery, histological findings prove the functionality and the malignant-free status of the transplanted tissue during the grafted period.</description><identifier>ISSN: 1058-0468</identifier><identifier>EISSN: 1573-7330</identifier><identifier>DOI: 10.1007/s10815-020-01850-2</identifier><identifier>PMID: 32556882</identifier><language>eng</language><publisher>New York: Springer US</publisher><subject>17β-Estradiol ; Acute lymphoblastic leukemia ; Adult ; Biopsy ; Bone marrow transplantation ; Cord blood ; Cord Blood Stem Cell Transplantation ; Cryopreservation ; Embryo Transfer ; Embryos ; Female ; Fertility ; Fertility Preservation ; Fertility Preservation - methods ; Follicle-stimulating hormone ; Follicles ; Gynecology ; Human Genetics ; Humans ; Immunohistochemistry ; Karyotypes ; Leukemia ; Live Birth ; Lymphatic leukemia ; Medicine ; Medicine &amp; Public Health ; Menopause ; Menstruation ; Ovarian Follicle - transplantation ; Ovaries ; Ovary - transplantation ; Precursor Cell Lymphoblastic Leukemia-Lymphoma - genetics ; Precursor Cell Lymphoblastic Leukemia-Lymphoma - pathology ; Precursor Cell Lymphoblastic Leukemia-Lymphoma - surgery ; Pregnancy ; Pregnancy, Multiple ; Remission ; Reproductive Medicine ; Translocation, Genetic - genetics ; Turkey - epidemiology ; Ultrasound ; Young Adult</subject><ispartof>Journal of assisted reproduction and genetics, 2020-08, Vol.37 (8), p.2033-2043</ispartof><rights>Springer Science+Business Media, LLC, part of Springer Nature 2020</rights><rights>Springer Science+Business Media, LLC, part of Springer Nature 2020.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c474t-92a7f1af3247e7e46509a2fb052188367601aa9380cdad5f754b8ce7736947503</citedby><cites>FETCH-LOGICAL-c474t-92a7f1af3247e7e46509a2fb052188367601aa9380cdad5f754b8ce7736947503</cites><orcidid>0000-0003-0815-3522 ; 0000-0003-4525-9027 ; 0000-0001-6101-1414 ; 0000-0002-3913-9224</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC7468030/pdf/$$EPDF$$P50$$Gpubmedcentral$$H</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC7468030/$$EHTML$$P50$$Gpubmedcentral$$H</linktohtml><link.rule.ids>230,314,727,780,784,885,27924,27925,53791,53793</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/32556882$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Sonmezer, Murat</creatorcontrib><creatorcontrib>Ozkavukcu, Sinan</creatorcontrib><creatorcontrib>Sukur, Yavuz Emre</creatorcontrib><creatorcontrib>Kankaya, Duygu</creatorcontrib><creatorcontrib>Arslan, Onder</creatorcontrib><title>First pregnancy and live birth in Turkey following frozen-thawed ovarian tissue transplantation in a patient with acute lymphoblastic leukemia who underwent cord blood transplantation</title><title>Journal of assisted reproduction and genetics</title><addtitle>J Assist Reprod Genet</addtitle><addtitle>J Assist Reprod Genet</addtitle><description>Purpose To report the first live birth after frozen-thawed ovarian transplantation in Turkey and the second case for an acute lymphoblastic leukemia (ALL) survivor in the world. Methods A 19-year-old patient underwent ovarian tissue cryopreservation (OTC) before cord blood transplantation in 2010. She was diagnosed as ALL with a bone marrow biopsy revealing 90% blast ALL-L2 type, and karyotype analyses indicated reciprocal translocation at t(9;22)(q34;q11). The patient received the Berlin-Frankfurt-Munster (BFM) protocol, and complete remission was achieved before fertility preservation. Serum AMH level was measured as 1.5 ng/ml, and 12 antral follicles were counted on ultrasound. She was informed about fertility preservation options and decided to proceed with OTC, with her signed consent before cord blood transplantation in April 2011. Ovarian tissue transplantation (OTT) was performed in 2017 when the patient was menopausal with serum FSH levels &gt; 100 IU/ml and estradiol &lt; 20 pg/ml and hematologically in molecular remission. Detailed molecular analysis, standard histology, and immunohistochemistry demonstrated that the thawed tissue is free of malignant cells. Results Six months following OTT, she had spontaneous menstruation with serum FSH 11 IU/ml and estradiol 53 pg/ml. Two consecutive IVF cycles yielded three top-quality embryos. Following three embryo transfer cycles, one fresh and two frozen, a healthy term live birth was achieved. Frozen-thawed-transplanted tissues were extracted during caesarean delivery upon the patient’s request after a total period of 25 months in vivo, and histopathological evaluation revealed that the tissue was free of leukemic infiltration. Conclusion The authors report the first pregnancy and live birth in Turkey and the second live birth in the world following transplantation of frozen-thawed ovarian tissue in a leukemia survivor. 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Public Health</topic><topic>Menopause</topic><topic>Menstruation</topic><topic>Ovarian Follicle - transplantation</topic><topic>Ovaries</topic><topic>Ovary - transplantation</topic><topic>Precursor Cell Lymphoblastic Leukemia-Lymphoma - genetics</topic><topic>Precursor Cell Lymphoblastic Leukemia-Lymphoma - pathology</topic><topic>Precursor Cell Lymphoblastic Leukemia-Lymphoma - surgery</topic><topic>Pregnancy</topic><topic>Pregnancy, Multiple</topic><topic>Remission</topic><topic>Reproductive Medicine</topic><topic>Translocation, Genetic - genetics</topic><topic>Turkey - epidemiology</topic><topic>Ultrasound</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Sonmezer, Murat</creatorcontrib><creatorcontrib>Ozkavukcu, Sinan</creatorcontrib><creatorcontrib>Sukur, Yavuz Emre</creatorcontrib><creatorcontrib>Kankaya, Duygu</creatorcontrib><creatorcontrib>Arslan, Onder</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>ProQuest Health and Medical</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Public Health Database</collection><collection>Technology Research Database</collection><collection>ProQuest SciTech Collection</collection><collection>ProQuest Natural Science Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central</collection><collection>ProQuest Central Essentials</collection><collection>Biological Science Collection</collection><collection>ProQuest Central</collection><collection>ProQuest Natural Science Collection</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central</collection><collection>Engineering Research Database</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>SciTech Premium Collection</collection><collection>ProQuest Health &amp; 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Methods A 19-year-old patient underwent ovarian tissue cryopreservation (OTC) before cord blood transplantation in 2010. She was diagnosed as ALL with a bone marrow biopsy revealing 90% blast ALL-L2 type, and karyotype analyses indicated reciprocal translocation at t(9;22)(q34;q11). The patient received the Berlin-Frankfurt-Munster (BFM) protocol, and complete remission was achieved before fertility preservation. Serum AMH level was measured as 1.5 ng/ml, and 12 antral follicles were counted on ultrasound. She was informed about fertility preservation options and decided to proceed with OTC, with her signed consent before cord blood transplantation in April 2011. Ovarian tissue transplantation (OTT) was performed in 2017 when the patient was menopausal with serum FSH levels &gt; 100 IU/ml and estradiol &lt; 20 pg/ml and hematologically in molecular remission. Detailed molecular analysis, standard histology, and immunohistochemistry demonstrated that the thawed tissue is free of malignant cells. Results Six months following OTT, she had spontaneous menstruation with serum FSH 11 IU/ml and estradiol 53 pg/ml. Two consecutive IVF cycles yielded three top-quality embryos. Following three embryo transfer cycles, one fresh and two frozen, a healthy term live birth was achieved. Frozen-thawed-transplanted tissues were extracted during caesarean delivery upon the patient’s request after a total period of 25 months in vivo, and histopathological evaluation revealed that the tissue was free of leukemic infiltration. Conclusion The authors report the first pregnancy and live birth in Turkey and the second live birth in the world following transplantation of frozen-thawed ovarian tissue in a leukemia survivor. As the transplanted tissues were removed during caesarean delivery, histological findings prove the functionality and the malignant-free status of the transplanted tissue during the grafted period.</abstract><cop>New York</cop><pub>Springer US</pub><pmid>32556882</pmid><doi>10.1007/s10815-020-01850-2</doi><tpages>11</tpages><orcidid>https://orcid.org/0000-0003-0815-3522</orcidid><orcidid>https://orcid.org/0000-0003-4525-9027</orcidid><orcidid>https://orcid.org/0000-0001-6101-1414</orcidid><orcidid>https://orcid.org/0000-0002-3913-9224</orcidid><oa>free_for_read</oa></addata></record>
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subjects 17β-Estradiol
Acute lymphoblastic leukemia
Adult
Biopsy
Bone marrow transplantation
Cord blood
Cord Blood Stem Cell Transplantation
Cryopreservation
Embryo Transfer
Embryos
Female
Fertility
Fertility Preservation
Fertility Preservation - methods
Follicle-stimulating hormone
Follicles
Gynecology
Human Genetics
Humans
Immunohistochemistry
Karyotypes
Leukemia
Live Birth
Lymphatic leukemia
Medicine
Medicine & Public Health
Menopause
Menstruation
Ovarian Follicle - transplantation
Ovaries
Ovary - transplantation
Precursor Cell Lymphoblastic Leukemia-Lymphoma - genetics
Precursor Cell Lymphoblastic Leukemia-Lymphoma - pathology
Precursor Cell Lymphoblastic Leukemia-Lymphoma - surgery
Pregnancy
Pregnancy, Multiple
Remission
Reproductive Medicine
Translocation, Genetic - genetics
Turkey - epidemiology
Ultrasound
Young Adult
title First pregnancy and live birth in Turkey following frozen-thawed ovarian tissue transplantation in a patient with acute lymphoblastic leukemia who underwent cord blood transplantation
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