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Growth and growth hormone therapy of children treated for leukaemia
C T Cowell1, C A Quigley, B Moore
1Institute of Endocrinology, Children's Hospital, Camperdown, Sydney, Australia.
Insights
Children treated for leukemia with cranial irradiation experienced significant growth deceleration. Growth hormone (GH) therapy improved height velocity, suggesting its consideration regardless of GH provocative test results.
Area of Science:
- Pediatric Endocrinology
- Oncology
- Growth Hormone Therapy
Background:
- Leukemia treatment, including chemotherapy and cranial irradiation, can impair growth in children.
- Growth deceleration is a common sequela, impacting height potential in survivors.
Purpose of the Study:
- To evaluate the efficacy of somatrem (growth hormone) therapy in children with growth failure post-leukemia treatment.
- To determine if growth hormone provocative test results influence treatment response.
Main Methods:
- 37 children with leukemia treated with chemotherapy and cranial irradiation were assessed.
- Somatrem therapy was initiated for those with growth rates below the 25th centile.
- Children were categorized into deficient and non-deficient groups based on peak GH response.
Main Results:
- Mean height SD decreased significantly from leukemia diagnosis to somatrem initiation.
- Somatrem therapy increased mean height velocity from 2.7 cm/year to 6.6 cm/year within 6 months.
- No significant difference in growth response was observed between sexes or GH-deficient/non-deficient groups.
Conclusions:
- Children with growth failure after leukemia treatment warrant consideration for growth hormone therapy.
- GH provocative test results should not be the sole determinant for initiating GH therapy.
Abstract:
A total of 37 children (24 male, 13 female) who had been treated for leukaemia with chemotherapy and 24 Gy cranial irradiation, and who were disease free for at least 18 months, were commenced on somatrem at a mean of 7.6 years (range, 4.8-12.1 years) after leukaemia diagnosis because of growth rate below the 25th centile for bone age. Peak GH response to provocation (exercise, arginine, insulin hypoglycaemia) was less than 20 milliunits/litre in 27 children (deficient group) and 20 milliunits/litre or more in 10 children (non-deficient group). The mean height SD decrease from diagnosis of leukaemia to commencement of somatrem was 1.98, 86% of the children decreasing by more than 1 SD. Those who were tall for age at leukaemia diagnosis and females were more severely affected. Mean (+/- SD) height velocity increased on somatrem from 2.7 +/- 1.1 to 6.6 +/- 2.2 cm/year during the first 6 months (n = 25), and to 6.0 +/- 1.7 cm/year during the first 12 months (n = 19). No difference in growth response was seen between the sexes or between the deficient and non-deficient groups. Catch-up growth occurred for the first 6 months only. It is concluded that children with a low growth rate after treatment of leukaemia should be considered for GH therapy irrespective of the results of GH provocative tests.