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Growth and growth hormone in children after bone marrow transplantation
1Department of Pediatrics, Karolinska Institute, Huddinge Hospital, Stockholm, Sweden.
Insights
Children undergoing bone marrow transplantation (BMT) for leukemia, especially with total body irradiation (TBI), show impaired growth and growth hormone (GH) deficiency. Those with severe aplastic anemia (SAA) maintained normal growth and GH levels.
Area of Science:
- Pediatric Endocrinology
- Hematology
- Oncology
Background:
- Bone marrow transplantation (BMT) is a critical treatment for severe aplastic anemia (SAA) and leukemia.
- Potential long-term complications, including growth disturbances, require thorough investigation.
Purpose of the Study:
- To evaluate growth and growth hormone (GH) status in children post-allogeneic BMT.
- To identify factors contributing to impaired growth in pediatric BMT recipients.
Main Methods:
- Longitudinal assessment of growth parameters and GH levels in 24 children post-BMT.
- GH deficiency diagnosed via provocation tests and 24-hour GH profiles.
- Comparison of outcomes between leukemia and SAA patient groups.
Main Results:
- Leukemia patients receiving total body irradiation (TBI) exhibited poor growth, with a mean height standard deviation score decrease to -1.73 at 4 years post-BMT.
- GH deficiency was diagnosed in 10/18 children by 3 years post-BMT.
- Children with SAA showed normal growth and GH levels, suggesting TBI as a key factor in growth impairment.
Conclusions:
- Total body irradiation (TBI) is strongly associated with impaired growth and growth hormone (GH) deficiency in pediatric BMT recipients for leukemia.
- Children undergoing BMT for SAA without TBI demonstrate normal growth and GH function.
- Further research into mitigating TBI-related growth complications is warranted.
Abstract:
Growth and growth hormone (GH) were investigated every year in 24 children after allogeneic bone marrow transplantation (BMT) for severe aplastic anemia (SAA) or leukemia. Conditioning included total body irradiation (TBI) in all cases of leukemia. The young leukemic children grew poorly. At 4 years after BMT, the mean standard deviation score for attained height had decreased from 0 to -1.73. GH deficiency was diagnosed with provocation tests. Three years after BMT, 10/18 children had a subnormal response. Ten children were further investigated with 24-hour GH profiles. Children with SAA had normal growth and GH levels. TBI seemed to be the major factor responsible for impaired growth.