FERTILITY PRESERVATION IN ADULT LYMPHOMA PATIENTS: A CONSENSUS‐BASED POSITION PAPER BY THE FONDAZIONE ITALIANA LINFOMI (FIL) & SOCIETà ITALIANA DELLA RIPRODUZIONE UMANA (SIRU)

Background: In this consensus-based position paper, the scientific societies Fondazione Italiana Linfomi (FIL) and Società Italiana della Riproduzione Umana (SIRU) reviewed main aspects and identified the optimal paths aimed to preserve and monitor fertility in patients diagnosed with lymphoma. Methods: The multi-disciplinary working group for this consensus-based position paper was composed by 5 onco-hematologists, 4 gynecologist or andrologists, 1 embryologist and 1 biologist, with the supervision of an international expert leader. A series of rank-ordering key questions were proposed according to the clinical relevance focusing on patients diagnosed with non-Hodgkin's lymphomas and Hodgkin lymphoma. The agreement among all the Panelists was scored by a web-based questionnaire according to the Delphi methodology (two rounds). All statements were newly discussed in a round robin way and confirmed for the drafting of the final recommendations. Results: Chemotherapy-induced gonadotoxicity is influenced by the type of agent, the dose intensity (high risk of infertility ≥80%, intermediate risk 40%–60%, low risk <20%, very low risk and unknown risk, and in women, also by age at treatment. The correct timing for onco-fertility counseling is as soon as possible, ideally at time of diagnosis, in order to increase patient's awareness and to allow timing optimization to apply FP techniques. An urgent referral pathway needs to be established between the Hematological and The Reproductive Centers with the aim to offer the onco-fertility counseling within 24–48 h. Blood and specialist exams to be performed during the pre-therapy counseling have been summarized. Oocyte cryopreservation is a well-established FP technique that should be proposed to patients after a personalized onco-fertility counseling, and the possibility to delay treatment of 10–14 days. Ovarian tissue cryopreservation could be proposed as a unique technique in patients with: therapeutic urgency, when chemotherapy has to be started within 10–14 day, when there is a high/moderate gonadotoxic risk, and if the patient's clinical conditions are feasible for surgery. To improve the safety of ovarian tissue transplantation for patients in complete and prolonged survival after lymphoma, the ovarian samples have to be analyzed in order to exclude the presence of neoplastic cells by using molecular and histological analyses prior to graft, especially for aggressive NHL histotypes. Post-pubertal males should be offered sperm cryopreservation. GnRHa should not be considered an alternative option for FP with cryopreservation techniques unless for women for whom these latter are contraindicated due to treatment start delay or safety issues. Indications on fertility tests to be carried out in the period following chemotherapy (1–5 years and >5 years) has been also discussed. Conclusion: These recommendations would be useful for clinicians who take care of young lymphoma patients to guarantee an evidence-based onco-fertility assessment and treatment during the oncologic pathway. The research was funded by: Ministry of Health, Italian Government, R.C. funds 2022, to the IRCCS Istituto Tumori "Giovanni Paolo II," Bari-Italy. Keywords: Late Effects in Lymphoma Survivors No conflicts of interests pertinent to the abstract.