Growth in children after bone marrow transplantation for advanced neuroblastoma compared with growth after transplantation for leukemia or aplastic anemia
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S M Willi1, K Cooke, J Goldwein
1Division of Endocrinology, Children's Hospital, Philadelphia, PA 19104.
Insights
Children undergoing bone marrow transplantation for neuroblastoma experience significantly impaired linear growth compared to leukemia or aplastic anemia patients. Intensive treatment regimens negatively impact growth velocity in these young cancer survivors.
Area of Science:
- Pediatric Oncology
- Hematology
- Endocrinology
Background:
- Bone marrow transplantation (BMT) is a critical treatment for advanced cancers and hematologic disorders.
- Assessing long-term effects of BMT, particularly on linear growth, is crucial for pediatric patient outcomes.
- Neuroblastoma treatment often involves intensive protocols with potential for significant side effects.
Purpose of the Study:
- To compare the linear growth of children with neuroblastoma post-BMT to those treated for leukemia and aplastic anemia.
- To evaluate the long-term growth trajectory in neuroblastoma survivors after BMT.
- To identify potential therapeutic factors contributing to growth disparities.
Main Methods:
- Retrospective analysis of linear growth (standard deviation scores) in 26 neuroblastoma patients versus 33 leukemia and 12 aplastic anemia patients who underwent BMT.
- Comparison of growth velocity between patient groups.
- 6-year follow-up study on long-term cancer survivors.
Main Results:
- Neuroblastoma patients exhibited significantly lower mean growth velocity (SD score: -2.83) compared to leukemia (-0.98 to -0.07) and aplastic anemia (-1.05) patients (p<0.005).
- Long-term follow-up showed continued poor growth in neuroblastoma survivors, unlike leukemia survivors who achieved near-normal growth by 2 years post-BMT.
- Intensive preparative regimens for neuroblastoma, including higher radiotherapy doses and cytotoxic agents, were implicated.
Conclusions:
- Intensive BMT preparative regimens for neuroblastoma have a significant negative impact on linear growth.
- Therapeutic differences in radiotherapy and chemotherapy contribute to growth inhibition in neuroblastoma patients.
- Pediatric cancer survivors treated with intensive BMT require careful monitoring for growth disturbances.
Abstract:
The linear growth of 26 children with progressive and advanced neuroblastoma treated with high-dose chemotherapy, total body irradiation, and bone marrow transplantation between 1978 and 1988 at the Children's Hospital of Philadelphia was compared with the growth of 33 children who had transplants for leukemia and of 12 who had transplants for aplastic anemia. The mean growth velocity, expressed as a standard deviation score, for the children who underwent bone marrow transplantation for neuroblastoma was -2.83. This was significantly (p less than 0.005) less than the standard deviation scores for children with transplants for acute lymphoblastic leukemia, acute nonlymphocytic leukemia, and aplastic anemia, which were -0.98, -0.07, and -1.05, respectively. A 6-year follow-up study of 32 long-term survivors of cancer revealed that the 11 patients with neuroblastoma continued to grow poorly, whereas a comparison group of 21 survivors of bone marrow transplantation for leukemia had essentially normal growth 2 years after the procedure. Major therapeutic differences between the two groups included the doses of local radiotherapy and the type and number of cytotoxic agents used. In comparison with the relatively mild growth-inhibiting effects of preparative regimens for leukemia and aplastic anemia, the very intensive preparative regimens used in patients with neuroblastoma have significant negative effects on growth.