For kids with cancer, a futuristic chance to save fertility

Talia Pisano, 2, stands in her bed at Lurie Children’s Hospital. Talia is getting tough treatment for kidney cancer that spread to her brain. She’s also getting a chance at having babies of her own someday. AP photo

Barely 2 years old, Talia Pisano is getting tough treatment for kidney cancer that spread to her brain. She’s also getting a chance of one day having babies of her own.

To battle infertility that cancer treatment sometimes can cause, Lurie Children’s Hospital — where the northwest Indiana girl is being treated — and some hospitals elsewhere around the country are trying a futuristic approach:

They’re removing and freezing immature ovary and testes tissue in hopes of being able to put it back when patients reach adulthood and want to start families.

No one knows yet if it will work, though it has in adults. More than 30 babies have been born to women who had ovarian tissue removed in adulthood, frozen and put back after treatment for cancer or other serious conditions.

The procedures are still experimental in children. There are challenges to making immature eggs and sperm from removed tissue suitable for conception.

Fertility researchers hope to refine the science while the first generation of children whose tissue has been put on ice grows up.

Families like Talia’s cling to that hope.

Talia, a dark-eyed toddler who loves princesses and Play-Doh, was treated last year for kidney cancer. But when it spread, her doctors at Lurie Children’s Hospital started harsher treatment, including brain radiation. In April, to try to preserve her future fertility, she had an ovary removed and frozen.

“It seemed very new and pretty amazing that we can do something like this and help her in a bigger way,” says her mom, Maria Pisano, of Griffith, Indiana.

Doctors face a delicate balance in broaching the idea of yet another medical procedure with families already hit with a horrible diagnosis and difficult treatment plan.

“We try to be thoughtful about the fact that their main focus and ours is on the survival of the child,” says Dr. Erin Rowell, a surgeon at Lurie.

Dr. Erin Rowell, medical director, Institute for Fetal Health, and assistant professor of surgery at Northwestern University Feinberg School of Medicine.

Still, she says many families are open to hearing about saving their child’s fertility.

“That often is the one piece of information that gives them a glimmer of hope — that we believe that their children will live long enough to grow into adulthood and have their own family,” Rowell says.

The tissue-removing surgeries are typically done while a child is sedated for another reason.

A baby boy in Belgium makes scientists think they’re on the right track. He was born to a woman who, when she was just 13, had ovarian tissue removed before undergoing harsh treatment for sickle cell anemia. Doctors think she had signs of puberty when the tissue was frozen, according to a recent medical journal report. Ten years later, the tissue was thawed, and portions were grafted onto her remaining ovary. She gave birth last November after a normal pregnancy.

She’s the youngest person to date to have had success. Though her eggs were likely more mature than those of pre-puberty girls, the results are “super exciting,” says Dr. Jill Ginsberg of Children’s Hospital of Philadelphia, a pioneer in the field.

Chemotherapy works by killing rapidly dividing cells — malignant cells but also hair follicles, digestive tract cells and sperm and eggs. Radiation can also damage these cells.

After the tissue is removed, some is stored in liquid nitrogen for the patient’s future use, and some is sent to a central research lab at Northwestern University, where scientists are studying ways to make it work.

Since 2008, Children’s Hospital of Philadelphia has saved tissue for about 40 girls 3 and older and 50 boys — the youngest was 3 months. A few have since died, but most still have tissue on ice, waiting for science and adulthood.

About 80 percent of children with cancer survive, “so we have the odds in our favor,” Ginsberg says.

Parents help doctors present the details, Ginsberg says. “Some kids want to know every detail. Others are, like, ‘I’ve heard enough.’ ”

When Hannah McStay, 8, of Mantua, New Jersey, was diagnosed with leukemia, the offer of ovary-freezing forced her mom to have a very grown-up conversation with her.

Now 11, with her leukemia in remission, Hannah says the chance for fertility is “a miracle.”

Talia Pisano stands in her room at Lurie Children’s Hospital. She’s getting tough treatment for kidney cancer that spread to her brain — and also getting a chance at having babies of her own someday despite the risks of her treatment. AP photo