What do you recommend for fertility preservation in pediatric patients with impending cyclophosphamide use for treatment of a rheumatic disease?

Cyclophosphamide (CYC) is an alkylating agent primarily used in the treatment of malignant lymphomas, and its gonadotoxic properties are well-established. CYC can cause ovarian toxicity via follicle atresia and granulosa cell apoptosis in females as well as oligospermia and azoospermia in males. In addition to its oncologic uses, CYC is also used to treat adult and pediatric rheumatic diseases such as Systemic Lupus Erythematosus, Systemic Sclerosis, ANCA-associated vasculitis, and others. Howev...

Fertility preservation, in the work I have done, is overlooked, or if addressed, not carried through in the majority of pediatric rheumatology patients receiving cyclophosphamide. This is very multifactorial however as to why. In the United States, there are numerous barriers to rheumatic disease patients being able to proceed with fertility preservation, no matter their age.

• KNOWLEDGE: Pediatric rheumatologists are less versed in fertility preservation than our pediatric oncology colleagues. ...

I am not a pediatric rheumatologist so I would need to defer to a pediatric rheumatologist regarding this question. However, the Euro lupus protocol 500mg q two weeks x 6, has not been shown to significantly reduce fertility. Moreover, impairment of ovarian function after cyclophosphamide therapy is based on age (in particular >30), duration of therapy, and cumulative dose. Thus, the fertility issues may be less of an issue in the pediatric population.