臨床婦人科産科63巻11号

2009年11月発行

今月の臨床 生殖医療のトピックス

卵巣組織凍結保存・自家移植の現状

著者： 鈴木直¹ 高江正道¹ 五十嵐豪¹ 杉下陽堂¹ 奥津由記¹ 石塚文平¹

所属機関： ¹聖マリアンナ医科大学産婦人科

ページ範囲：P.1373 - P.1377

文献概要

はじめに

　近年，がん患者に対する手術療法，化学療法や放射線療法を中心とした集学的治療法の進歩に伴ってその治療成績はめざましく向上してきており，米国のNational Cancer Institute（NCI）のデータでも若年がん患者の5年生存率は69％（1975～1984年）から77％（1985～1995年）へと改善している^1）．若年女性がん患者における抗がん剤による治療後の卵巣機能維持は，妊孕性温存という観点のみならず女性としてのQOL保持に欠かせないものとなる．近年，化学療法施行前に卵巣組織を体外に摘出し凍結保存する試みが欧州を中心に臨床応用されており，若年女性血液腫瘍患者の卵巣組織を凍結後自家移植し生児を得たとする報告が続いている．本稿では，卵巣組織凍結保存・自家移植の現状について解説する．

参考文献

1） Smith MA, Gurney JG, Gloeckler Ries LA : Cancer Incidence and Survival among Children and Adolescents : United States SEER Program 1975─1995, Cancer Statistics Branch, Cancer Surveillance Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute. http://www-seer.ims.nci.nih.gov

2） Meadows AT : Pediatric cancer survivors : past history and future challenges. Curr Probl Cancer 27 : 112─126, 2003

3） Lutchman Sigh L, Davies M, Chatterjee R : Fertility in female cancer survivors : pathophysiology, preservation and the role of ovarian reserve testing. Human Reprod Update 11 : 69─89, 2005

4） Gadducci A, Cosio S, Genazzani AR : Ovarian function and childbearing issues in breast cancer survivors. Gynecological Endocrinology 23 : 625─631, 2007

5） Brougham MFH, Wallace WHB : Subfertility in children and young people treated for solid and haematological malignancies. British J of Haematology 131 : 143─155, 1995

6） Blumenfeld Z : Preservation of fertility and ovarian function and minimalization of chemotherapy associated gonadotoxicity and presmature ovarian failure ; the role of inhibin-A and-B as maker. Mol Cell Endocrionol 187 : 93─105, 2002

7） Behringer K, Breuer K, Reineke T, et al : A report from the German Hodgikin's Lymphoma Study Group. Secondary amenorrhea after Hodgkin's lymphoma is influenced by age at treatment, stage of disease, chemotherapy regimen and the use of oral contraceptives during therapy. J Clin Oncol 23 : 7555─75564, 2005

8） Morice P, juncker L, Rey A, et al : Ovarian transposition for patients with cervical carcinoma treated by radiosurgical combination. Fertil Steril 29 : 199─206, 2000

9） Jeruss JS and Woodruff TK : Preservation of fertility in patients with cancer. N Engl J Med 26 : 902─911, 2009

10） Donnez J, Martinez-Madrid B, Jadoul P, et al : Ovarian tissue cryopreservation and transplantation : a review. Human Reprod Update 12 : 519─535, 2006

11） von Wolf M, Donnez J, Hovatta O, et al : Cryopeservation and autotransplantation of human ovarian tissue prior to cytotoxic therapy-A technique in its infancy but already successful in fertility preservation. E J Cancer 2009（in press）

12） Ino M, Saito J, Taniuchi A, et al : Cryopreservation and heterotopic autotransplantation of ovarian tissue in mouse. The St. Marianna Medical Journal 35 : 177─189, 2007

13） Lee DM, Yeoman RR, Battaglia DE, et al : Live birth after ovarian tissue transplant. Nature 428 : 137─138, 2004

14） Elezovic I, Colovic M, Tomin D, et al : Pregnancy after treatment of secondary acute promyelocytic leukemia following Hodgkin's disease : a case report. Medical Oncology 17 : 222─224, 2000

15） 日本病理剖検輯報，日本病理学会編第46輯，2004

16） Sancez M, Rosello-Sastre E, Teruel J, et al : Incidence of micrometastasses in women with breast cancer requesting ovarian cryopreservation to preserve fertility. Abs O-108, i43, 23rd Annual Meeting of the ESHURE, Lyon, France.

17） Donnez J, Dolmans MM, Demylle D, et al : Restortion of ovarian function after orthotopic（intraovarian and periovarian）translantation of cryopreserved ovarian tissue in a woman treated by bone marrow transplantation for sickle cell anemia : Case report. Human Reprod 21 : 183─188, 2006

18） Elizur SE, Chian RC, Pineau CA, et al : Fertility preservation treatment for young women with autoimmune diseases facing treatment with gonadotoxic agents. Rheumatology 47 : 1506─1509, 2008

19） Manger K, Wildt L, Kalden JR, et al : Prevention of gonadal toxicity and preservation of gonadal function and fertility in young women with systematic lupus erythematosus treated by cyclophosphamide : The PREGO-Study. Autoimmunity Reviews 5 : 269─272, 2006

20） Carre-Pigeon F, Schubert B : Female fertility preservation in autoimmune diseases : possibilities and practices in France. Gynecologie Obstetrique Fertilite 35 : 853─860, 2007