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Growth in children following irradiation for bone marrow transplantation
S Bushhouse1, N K Ramsay, O H Pescovitz
1Minnesota Department of Health, University of Minnesota, Minneapolis.
Insights
Pediatric bone marrow transplant (BMT) patients receiving total body irradiation (TBI) experienced significant growth suppression. Leukemia patients showed height loss for at least four years post-transplant.
Area of Science:
- Pediatric Hematology/Oncology
- Transplantation Immunology
Background:
- Bone marrow transplantation (BMT) is a critical treatment for various pediatric hematologic and oncologic conditions.
- Growth is a significant concern for pediatric patients undergoing BMT due to intensive treatment protocols.
- Understanding post-transplant growth patterns is essential for long-term patient management and quality of life.
Purpose of the Study:
- To analyze longitudinal height data in pediatric patients following BMT.
- To compare growth outcomes between patients with aplastic anemia (AA) and leukemia (ANLL, ALL).
- To identify factors influencing post-BMT growth suppression.
Main Methods:
- Longitudinal height data from 46 pediatric BMT patients (18 AA, 19 ANLL, 9 ALL) were analyzed.
- Patients received high-dose cyclophosphamide and irradiation (TLI for AA, TBI for leukemia).
- Growth standard deviation scores and growth velocities were calculated and compared.
Main Results:
- Aplastic anemia patients showed a statistically significant reduction in height 3 years post-BMT.
- Leukemia patients exhibited significant height loss starting at 1 year post-BMT, persisting for at least 4 years.
- Leukemia patients had significantly below-median growth velocities for 3 years post-BMT.
- Graft-versus-host prophylaxis with ATG/steroids/methotrexate showed less growth suppression than methotrexate alone.
- No significant associations were found between growth and prepubertal status, GVHD, endocrine function, or prior therapies in leukemia patients.
Conclusions:
- Pediatric patients undergoing BMT, especially those receiving TBI, are at high risk for significant growth suppression.
- Leukemia patients demonstrate more pronounced and prolonged growth deficits compared to aplastic anemia patients.
- Graft-versus-host disease prophylaxis strategies may influence post-transplant growth.
Abstract:
Longitudinal height data from 46 pediatric bone marrow transplant (BMT) patients, including 18 with aplastic anemia (AA), 19 with acute nonlymphoblastic leukemia (ANLL), and 9 with acute lymphoblastic leukemia (ALL), were analyzed to assess growth posttransplantation. Patients were prepared for BMT with high-dose cyclophosphamide followed by 7.5 Gy single-dose irradiation; AA patients received total lymphoid irradiation (TLI), and leukemia patients received total body irradiation (TBI). AA patients demonstrated reduced height posttransplant as reflected in a negative mean standard deviation score. The observed reduction was statistically significant only at 3 years following transplant. In contrast, leukemia patients showed a significant loss in relative height that was first visible at 1 year post-BMT and continued until at least 4 years post-BMT. Mean growth velocities in the leukemia patients were significantly below median for the 3 years following transplant. With a median follow-up of 4 years, antithymocyte globulin plus steroids in combination with methotrexate as graft vs. host prophylaxis was associated with less severe growth suppression than methotrexate alone, while there were no significant associations between growth during the first 2 years following transplant and prepubertal status at transplant (as defined by age), graft vs. host disease, thyroid or gonadal function, or previous therapies received by the leukemia patients. Children undergoing marrow transplantation, particularly those receiving TBI, are at significant risk of subsequent growth suppression.