Concordant AML in Twin Sisters: Impact of Prepubertal Cancer Treatment
Posted: Tuesday, March 24, 2020
A case report, published in the Journal of Ovarian Research, identified that the prepubertal state seems to serve as protection of female fertility after oncologic treatment. Tanja Burnik Papler, MD, PhD, of the University Medical Center Ljubljana, Slovenia and colleagues, reported on a set of monozygotic twins who both experienced acute myeloid leukemia (AML), shared the same germline and somatic C/EBPA gene mutation, but had different reproductive results: one experienced premature ovarian failure, whereas the other conceived naturally.
The first twin sister was diagnosed with AML at 21 months. She was treated with cytostatic medications and then underwent bone marrow transplantation; the donor was her twin sister. After 27 years, she remains disease-free and has regular periods. After 4 years of trying to conceive, she was seen by an infertility specialist. She underwent hysteroscopic uterine septum removal and laparoscopic enucleation of bilateral paraovarian cysts. After these procedures, she conceived naturally.
The second twin sister was diagnosed with AML at age 15. She was treated with chemotherapy and cranial radiation and after 10 years experienced a relapse. She then received chemotherapy and had bone marrow transplantation. She had a normal menstrual cycle until she experienced the relapse. After the second treatment, she became amenorrhoeic and is now part of an oocyte donation program.
“Although prepubertal oncological treatment does not seem to cause immediate infertility, it is important to inform these girls and their parents about future fertility and to offer fertility preservation prior to the start of oncological treatment,” the authors concluded.
Disclosure: The authors reported no conflicts of interest.