Video summary
Multiple myeloma primarily affects fertility through indirect mechanisms rather than the disease itself, as chronic inflammation and specific treatments play a significant role in gonadotoxicity. Historically, studies on this topic have been limited because patients were typically diagnosed at an older age, but the increasing number of younger patients receiving a diagnosis has made it essential to analyze fertility issues within this field. Key treatments known to impact fertility include alkylating agents and high-dose melphalan used in transplants, as well as cyclophosphamide, which has a well-documented effect on reproductive health. In contrast, newer therapies such as monoclonal antibodies and CAR-T cell therapy appear to have a smaller negative impact on fertility compared to traditional cytotoxic treatments.
Recent data from studies supervised by Dr. Annarita Ruggero highlight promising outcomes for patients undergoing CAR-T cell therapy, with reports of over 24 pregnancies across various diseases in European centers. Notably, male patients with multiple myeloma have also achieved successful pregnancies resulting in healthy births, although these instances were often facilitated by reproductive assisted methods rather than natural conception alone. While the sample size remains relatively small, these findings offer a very important and encouraging message for both clinicians and patients, suggesting that fertility preservation is achievable even after aggressive cancer treatments. The availability of such advanced therapies to younger patients not only improves long-term survival prospects but also supports their quality of life by addressing reproductive concerns early on.
Despite these positive developments, current fertility counseling remains inconsistent across different medical centers, with a notable lack of standardized guidelines for managing this aspect of patient care. To address this gap, the medical community must collaborate closely with fertility experts to establish clear options and optimize treatment plans that consider long-term outcomes. Early referral for fertility counseling is crucial, ideally at the time of diagnosis or during the initial stages of treatment for patients who wish to preserve their reproductive potential. By working together across different specialties, healthcare providers can ensure that patients receive comprehensive care that balances immediate disease management with the preservation of future family-building opportunities.
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>> Uh, the way myeloma can impact on
fertility, baby, uh, mainly indirect.
So, it's not the disease itself, but the
rather the condition that are indeed
associated with it.
Such as chronic inflammation
and uh,
the different treatment that we have to
propose to patient. This field generally
has not really been
There are no big studies dealing with
with the issue of fertility in myeloma
patients since generally they are older
patient. Uh, but nowadays we're seeing
more and more younger patients that have
a diagnosis of multiple myeloma and we
really think that the the issue of
fertility should be indeed
studied and analyzed in the field of
myeloma.
So, we do know that alkylating agents
mainly
indeed have an effect on fertility on
patients.
They have indeed a gonadotoxic effect.
In particular, the patient that
underwent transplantation with high-dose
melphalan
may be indeed effective on fertility.
Also, cyclophosphamide that historically
has been often used in patient with
multiple myeloma
could impact on fertility. Uh, there are
less experience with new drugs. In
particular, monoclonal antibodies.
What we saw in our study with that we
run under the supervision of Dr.
Annarita Ruggero with the EBM T, we saw
that patient that underwent CAR-T cells
may have indeed smaller impact on
fertility compared to other cytotoxic
treatments across different disease.
In particular, we describe the larger
view of the larger cohort of pregnancies
after car-T cells from the centers from
the European centers reported more than
24 pregnancies across different disease
and we also had
a disease of multiple myeloma from male
patient with multiple
myeloma diagnosis that indeed achieved a
pregnancy with a healthy bird. We know
reproductive
assisted methods, so it was a natural
pregnancies that was
mainly the
the were frequent in in our study
and that's of course it's only a few
patients, but we have some good data
that are very promising and this is a
very important match message that we
want to distribute to both clinicians,
but also patient with this diagnosis.
>> Okay.
>> We saw that in our cohort, we we indeed
had a number of reported pregnancies 24
in the tail.
In all those patient that indeed
underwent car-T cells in and of course
we expect that younger patients that
have access to this treatment in earlier
line benefit also from a long life
perspective in particular we address the
issue of fertility.
What we also saw from our study is that
at the moment fertility counseling is
very jeopardized across the different
center and there are missing some
guidelines for patients. So what we
really think is that as a community we
need to set up and we we need to to
discuss about the options for our
patients and to really address this
point of optimizing some guidelines
in managing this aspect for our
patients.
So, of course, there are the different
different
ways to preserve fertility across the
different patients
that are common and for that reason we
really need to work together with
with fertility experts both in the
female and the male population. What we
really think is that early access is
really key for our patients. So, early
referral potentially at diagnosis or
during the very first steps for stages
in the patient that want to preserve the
to to
have some fertility counseling. And for
that reason we really need to
collaborate across the different
specialists in order to optimize the
treatment of our patients and thinking
on the long way and thinking to
long-term outcomes and quality of life.
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