Is It Worth the Effort?
H allak et al. 1 described sperm quality in 25 patients with leukemia before and after cryopreservation including 3 patients with acute myeloid leukemia (AML). They suggest that sperm cryopreservation should be offered to all men of reproductive age before the initiation of therapy for leukemia. We would like to support this suggestion with our own results obtained from long term AML survivors who were treated with high doses of cytarabine (AraC)-and daunorubicin (DNR)-based chemotherapy, because to our knowledge the effects of this therapy on gonadal functions are not known. Furthermore, our study results demonstrate some problems associated with sperm collection in patients with AML.
Andrologic examination of 5 middle-aged men with various types of AML diagnosed according to the French-American-British classification 2 was performed at least 1 year after the end of chemotherapy given in the U ยดHKT-911 study 3 (Table 1). Informed consent for the treatment and the andrologic examination was obtained from all patients. Patients received 4 -5 chemotherapy courses that were the 3 ฯฉ 7 induction (or consolidation) cycle with 3 doses of DNR, 45 mg/m 2 /day, and AraC, 200 mg/m 2 /every 12 hours, in 3-hour infusions for 7 days and 2-3 consolidation cycles comprised of high doses of AraC, 2000 mg/m 2 /every 12 hours, in 3-hour infusions for 5 days and DNR, 45 mg/m 2 /day, on Days 4 and 5. Three patients (Patients 3-5) received the consolidation cycle containing etoposide, 100 mg/ m 2 /day, for 5 days and mitoxantrone, 10 -12 mg/m 2 /day, on Days 1, 3, and 5. The cumulative doses given to each patient are presented in Table 1.
Spermiologic examination was performed by the classic microscopic method. 4 Only one of the five patients (Patient 1) had completely normal spermiologic findings according to World Health Organization criteria 5 but the patient experienced erectile dysfunction after chemotherapy and required treatment with yohimbine and mesterolone. Decreased ejaculate volume was noted in Patient 2. Prolonged time of passing, decreased propulsivity (penetration) index, and decreased average spermatozoal velocity was found in Patient 3. Severe oligoasthenozoospermia with only sporadic motile spermatozoa in the semen was observed in Patients 4 and 5 in which the time of passing, propulsivity index, and average spermatozoal velocity were not measurable (Table 1). Spermiologic findings in Patients 1-3 were not likely to cause infertility but severe oligoasthenozoospermia in Patients 4 and 5 most likely would lead to infertility.
Although our patients were older (ages 42-59 years) than the majority of fathers usually are, our results are interesting because