Kids with can­cer get chance at sav­ing fer­til­ity


Barely 2 years old, Talia Pisano is get­ting tough treat­ment for kid­ney can­cer that spread to her brain. She’s also get­ting a chance at hav­ing ba­bies of her own some­day.

To bat­tle in­fer­til­ity some­times caused by can­cer treat­ment, some chil­dren’s hos­pi­tals are try­ing a fu­tur­is­tic ap­proach: re­mov­ing and freez­ing im­ma­ture ovary and testes tis­sue, with hopes of be­ing able to put it back when pa­tients reach adult­hood and want to start fam­i­lies. No one knows yet if it will work. It has in adults — more than 30 ba­bies have been born to women who had ovar­ian tis­sue re­moved in adult­hood, frozen, and put back af­ter treat­ment for can­cer or other se­ri­ous con­di­tions. In lab an­i­mals, it’s worked with frozen and thawed testes tis­sue.

But the pro­ce­dures are still ex­per­i­men­tal in chil­dren who haven’t reached pu­berty, and too new to have been at­tempted. There are chal­lenges to mak­ing im­ma­ture eggs and sperm from re­moved tis­sue suit­able for conception. Still, fer­til­ity re­searchers hope to re­fine the science while the first gen­er­a­tion of chil­dren whose tis­sue has been put on ice grows up.

Fam­i­lies like Talia’s are cling­ing to that op­ti­mism. The dark-eyed tod­dler who loves princesses and play dough had an ovary re­moved and frozen in April. She was treated for kid­ney can­cer last year but when it spread, doc­tors started harsher treat­ment in­clud­ing brain ra­di­a­tion.

“It seemed very new and pretty amaz­ing that we can do some­thing like this and help her in a big­ger way,” said her mom, Maria Pisano, of Grif­fith, In­di­ana.

“It def­i­nitely brought some peace” and raised hope for Talia’s fu­ture, Pisano said.

Doc­tors face a del­i­cate bal­ance in broach­ing the idea of yet another med­i­cal pro­ce­dure when fam­i­lies have been hit with a hor­ri­ble di­ag­no­sis and dif­fi­cult treat­ment plan. The tis­sue-re­mov­ing surg­eries are typ­i­cally done while a child is be­ing se­dated for another rea­son.

“We try to be thought­ful about the fact that their main fo­cus and ours is on the sur­vival of the child,” said Dr. Erin Row­ell, a sur­geon at Chicago’s Lurie Chil­dren’s Hos­pi­tal, where Talia is be­ing treated.

Yet, Row­ell added, many fam­i­lies are open to hear­ing about sav­ing their child’s fer­til­ity.

“That of­ten is the one piece of in­for­ma­tion that gives them a glim­mer of hope — that we be­lieve that their chil­dren will live long enough to grow into adult­hood and have their own fam­ily,” she said.

‘Su­per ex­cit­ing re­sults’

A baby boy in Bel­gium makes sci­en­tists think they’re on the right track. He was born to a woman who at age 13 had ovar­ian tis­sue re­moved be­fore un­der­go­ing harsh treat­ment for sickle cell ane­mia. Doc­tors be­lieve she had signs of pu­berty when the tis­sue was frozen, ac­cord­ing to a re­cent med­i­cal jour­nal re­port. Ten years later the tis­sue was thawed, and por­tions were grafted onto her re­main­ing ovary. She gave birth last Novem­ber af­ter a nor­mal preg­nancy.

She is the youngest per­son to date to have had suc­cess. Although her eggs were likely more ma­ture than those of pre­pu­berty girls, the re­sults are “su­per ex­cit­ing,” said Dr. Jill Gins­berg of Chil­dren’s Hos­pi­tal of Philadelphia, a pi­o­neer in the field.

The irony of can­cer treat­ment is that it can save lives while de­stroy­ing the chance to cre­ate a new life. Chemo­ther­apy works by killing rapidly di­vid­ing cells. These in­clude ma­lig­nant cells but also hair fol­li­cles, di­ges­tive tract cells, and sperm and eggs. Ra­di­a­tion can also dam­age these cells.

Dr. John Lan­tos, bioethics chief at Chil­dren’s Mercy Hos­pi­tal in Kansas City, Mis­souri, says of­fer­ing chil­dren the ex­per­i­men­tal fer­til­ity-pre­serv­ing pro­ce­dures poses no eth­i­cal prob­lems “as long as there’s in­formed con­sent and a de­sire to do it.”

Fed­eral guide­lines say there should be min­i­mal risk to chil­dren in­volved in re­search, and risks need to be weighed against po­ten­tial ben­e­fits, he said.

“Kids them­selves when they grow up would likely ap­pre­ci­ate hav­ing that (fer­til­ity) op­tion,” he said.


(Top) Talia Pisano, sec­ond from right in blue dress, cel­e­brates her sec­ond birth­day with fam­ily and friends in Wheaton, Illi­nois, June 13. Talia is get­ting tough treat­ment for kid­ney can­cer that spread to her brain, June 11. (Above) Talia Pisano stands in her bed at Lurie Chil­dren’s Hos­pi­tal in Chicago.

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