Ovarian Tissue Cryopreservation in Post Pubertal (OTC-Post Pubertal)

Official title

Ovarian Tissue Cryopreservation for Fertility Preservation in Post-Pubertal Children Facing a Fertility Threatening Diagnosis or Treatment Regimen

Overview

The purpose of this study is to safely remove ovarian tissue in pediatric patients, who are at risk for infertility from their medical treatment, for freezing for future restoration of fertility and hormone function.

Detailed description

Participants are invited to take part in this study because they will be treated with chemotherapy, radiation and/or surgery that will likely affect the child's ovaries and cause the child to become infertile (unable to become pregnant) in the future.

The ovaries are reproductive glands found only in females. These glands are located in the pelvis (hip area). The ovaries produce eggs and female hormones. During each monthly menstrual cycle, an egg is released from one ovary. This study seeks to find out if removing an ovary in adolescents and children who have reached puberty, and who are about to undergo chemotherapy and/or radiation may preserve, or keep, their ability to have children in the future. The optional ovarian tissue that is removed for research will also be used to study better ways to store the ovarian tissue and to improve of the tissue in the future.

This study has two parts: the removal of the ovarian tissue, and the storage of the ovarian tissue. A process called Ovarian Tissue Cryopreservation will be used to store the removed ovarian tissue. This kind of freezing is a special method that is used to try to prevent the eggs from being damaged, and to keep them frozen for a long time. The frozen tissue will be available to the child to be used at a later time.

As a part of the study the investigator is asking participants to donate a 3-4mm biopsy (less than 10% of the ovary) of their ovarian tissue to future research before it is stored for their own use. The investigator also enrolls patients in a database study for yearly survey evaluation for long term outcome of ovarian tissue removal and potential restoration.

Ovarian Tissue Cryopreservation involves a surgical procedure where ovarian tissue of post pubertal patients is surgically removed and frozen, with the ultimate goal that their tissue may be used in the future to restore fertility when experimental techniques emerge from the research pipeline. Participation in the study is voluntary.

Interventions

• Procedure Laparoscopic surgery
  Surgery used to remove the child's ovary tissue is called laparoscopic surgery. Laparoscopic surgery employs a telescope-like instrument called laparoscope. The laparoscope will be put into the child's belly through a small (about half an inch) cut just below the belly button. Two or three other cuts may be made to allow for other instruments to help remove one of the ovaries. The surgeon will then look at both ovaries before the removal of one. Both of the child's ovaries must appear normal and

Primary outcome measures

• Ovarian Tissue Freezing for Fertility Preservation in Post-Pubertal Children Facing a Fertility Threatening Medical Diagnosis or Treatment Regimen [Time frame: 3 months]

Secondary outcome measures (1)

• Annual survey follow-up for participants who undergo ovarian tissue cryopreservation [Time frame: yearly for up to 20 years]

Eligibility criteria

Inclusion criteria

• Post-pubertal individuals < 30 years of age
• Will undergo imminent surgery, chemotherapy or radiation therapy that has implications on future fertility and reproductive hormone potential: any health condition or malignancy that requires removal of all or part of one or both ovaries, whole abdomen or pelvic irradiation≥ 10Gy in post-pubertal girls or ≥15 Gy in pre- pubertal girls
• total body irradiation, and
• alkylating-intensive chemotherapy

• cyclophosphamide cumulative dose ≥7.5 g/m2
• any treatment regimen containing procarbazine
• busulfan cumulative dose >600 mg/m2
• alkylating chemotherapy conditioning prior to stem cell transplantation

• combination of any alkylating agent with total body irradiation or whole abdomen or pelvic radiation
• cranial radiation ≥30 Gy
• summed alkylating agent dose score ≥3 (Green et al., 2009)
• cyclophosphamide equivalent dose (CED) ≥ 4,000 mg/m2 (Green et al., 2014)
• Patients may have newly diagnosed or relapsed disease. Those who were not enrolled at diagnosis are eligible even if they have received therapy that is viewed as likely to result in complete and permanent loss of ovarian function. However, these patients will be required to provide a 4mm punch biopsy of their tissue for research.

Exclusion criteria

• Patients with no anticipated oncologic therapies
• Pregnant children
• Children with one ovary
• Children deemed high risk for perioperative complications
• Patients unable to provide consent/assent (i.e. significant psychiatric problems/cognitive delay)

Criteria are shown verbatim from the registry (in English). Final eligibility is always assessed by the study center.

Healthy volunteers: No

Study design

Observational model

Other

Study locations

United States · 1 center

• Ann &Robert H Lurie Children's Hospital — Chicago

Publications

• Armenian SH, Landier W, Hudson MM, Robison LL, Bhatia S; COG Survivorship and Outcomes Committee. Children's Oncology Group's 2013 blueprint for research: survivorship and outcomes. Pediatr Blood Cancer. 2013 Jun;60(6):1063-8. doi: 10.1002/pbc.24422. Epub 2012 Dec 19. PMID 23255494
• Barton SE, Najita JS, Ginsburg ES, Leisenring WM, Stovall M, Weathers RE, Sklar CA, Robison LL, Diller L. Infertility, infertility treatment, and achievement of pregnancy in female survivors of childhood cancer: a report from the Childhood Cancer Survivor Study cohort. Lancet Oncol. 2013 Aug;14(9):873-81. doi: 10.1016/S1470-2045(13)70251-1. Epub 2013 Jul 13. PMID 23856401
• Ward E, DeSantis C, Robbins A, Kohler B, Jemal A. Childhood and adolescent cancer statistics, 2014. CA Cancer J Clin. 2014 Mar-Apr;64(2):83-103. doi: 10.3322/caac.21219. Epub 2014 Jan 31. PMID 24488779
• Martin JR, Kodaman P, Oktay K, Taylor HS. Ovarian cryopreservation with transposition of a contralateral ovary: a combined approach for fertility preservation in women receiving pelvic radiation. Fertil Steril. 2007 Jan;87(1):189.e5-7. doi: 10.1016/j.fertnstert.2006.04.051. Epub 2006 Nov 2. PMID 17084399
• Paradisi R, Fabbri R, Magnani V, Battaglia C, Venturoli S. A new simple technique of laparoscopic temporary ovarian suspension in addition to ovarian cryopreservation for women prior to posterior pelvic radiation. Gynecol Oncol. 2010 May;117(2):385-6. doi: 10.1016/j.ygyno.2010.01.018. Epub 2010 Feb 13. No abstract available. PMID 20153882
• Fernbach A, Lockart B, Armus CL, Bashore LM, Levine J, Kroon L, Sylvain G, Rodgers C. Evidence-Based Recommendations for Fertility Preservation Options for Inclusion in Treatment Protocols for Pediatric and Adolescent Patients Diagnosed With Cancer. J Pediatr Oncol Nurs. 2014 Jul;31(4):211-222. doi: 10.1177/1043454214532025. Epub 2014 May 5. PMID 24799444
• Rowell,EE. Optimal Technique for Laparoscopic Oophorectomy for Ovarian Tissue Cryopreservation in Pediatric Girls In: Woodruff TK GY, ed. Pediatric and Adolescent Oncofertility2017:243-250
• Practice Committee of American Society for Reproductive Medicine. Fertility preservation in patients undergoing gonadotoxic therapy or gonadectomy: a committee opinion. Fertil Steril. 2013 Nov;100(5):1214-23. doi: 10.1016/j.fertnstert.2013.08.012. Epub 2013 Sep 5. PMID 24011612

Identifiers

NCT: NCT05309746 · 2017-1149

Primary sources (government registries)

• ClinicalTrials.gov (US NIH)

View this study on ClinicalTrials.gov ↗