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Case Reports
AB
Figure 2. Transplantation of ovarian tissue. (A)The first transplantation was conducted in November 2017. In total 27 ovarian tissue pieces of size 1-2 mm x4 mm were thawed and transplanted. The majority of ovarian pieces were implanted in subcortical pockets using microsurgical instruments (ten in the right ovary, and five in the left ovary) and 12 pieces in peritoneal pockets in the mesosalpinx. All pockets were closed by non-absorbable sutures 6-0. The surgery and post- operative period were uneventful. The second transplantation included 19 thawed pieces. Same technique as previous transplant. (B) A modified laparoscopic technique was used, to allow the ovary being grasped with Babcock forceps and exteriorized through the anterior abdominal wall using a 3 cm incision to facil- itate inserting the tissue pieces.
leukemic cells in the ovarian tissue. We believe important aspects to sustain a future plausible transplantation of the ovarian tissue include the performance of OTC at a con- firmed remission stage, as well as the availability of using a relatively large portion of the OTC for safety assess- ments. Only if these assessments point towards a low likelihood of risks can a decision to transplant ovarian tis- sue back to a patient cured from cancer been made when she aims at regaining fertility.
Kenny A. Rodriguez-Wallberg,1,2 Milan Milenkovic,1,2 Kiriaki Papaikonomou,3 Victoria Keros,2 Britt Gustafsson,4 Fotios Sergouniotis,1,2 Ida Wikander,2 Ronak Perot,5
Birgit Borgström,1 Per Ljungman6 and Gisela Barbany7
1Department of Oncology-Pathology, Karolinska Institutet; 2Department of Reproductive Medicine, Division of Gynecology and Reproduction, Karolinska University Hospital; 3Department of Women’s and Children’s Health, Division of Obstetrics and Gynecology, Karolinska Institutet; 4Department of Women’s and Children’s Health, Division of Pediatric Oncology, Karolinska Institutet; 5Department of Gynecology, Division of Gynecology and Reproduction, Karolinska University Hospital; 6Department of Cellular Therapy and Allogeneic Stem Cell Transplantation, Karolinska University Hospital and Division of Hematology, Department of Medicine Huddinge, Karolinska Institutet and 7Department of Molecular Medicine and
Surgery, Karolinska Institutet and Department of Clinical Genetics, Laboratory Division Karolinska University Hospital, Stockholm, Sweden
Correspondence: KENNY A. RODRIGUEZ-WALLBERG - kenny.rodriguez-wallberg@ki.se doi:10.3324/haematol.2021.278828
Received: March 23, 2021.
Accepted: June 28, 2021.
Pre-published: July 8, 2021.
Disclosures: the authors declare that they have no competing financial interests.
Contributions: KARW designed the study, performed surgery and assisted reproductive treatments, collected and analyzed data, and wrote the manuscript together with MM and GB; MM, KP, RP performed surgery; FS, IW and MM performed assisted reproductive treatments; VK performed cryopreservation and thawing of ovarian tissue; BG, BB and PL collected data on clinical follow-up;
GB performed the molecular investigations for evaluation of ovarian tissue. All authors approved the last version of the manuscript.
Acknowledgments: we are grateful to Hanna Nilsson at Karolinska Institutet for expert assistance in the preparation of the manuscript. We kindly acknowledge Katja Pokrovskaja Tamm for her expert assistance at the childhood leukemia biobank of Karolinska Institutet.
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