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Growth in children after bone marrow transplantation
M Bozzola1, G Giorgiani, F Locatelli
1Department of Pediatrics, University of Pavia, IRCCS Policlinico San Matteo, Italy.
Hormone Research
|January 1, 1993
Summary
Children undergoing bone marrow transplantation (BMT) with prior cranial irradiation experienced earlier growth failure compared to those receiving chemotherapy and total body irradiation (TBI) alone.
Area of Science:
- Pediatric Endocrinology
- Hematology/Oncology
- Radiation Oncology
Background:
- Bone marrow transplantation (BMT) is a critical treatment for pediatric malignancies.
- Growth disturbances are a significant concern following BMT in prepubertal children.
- The impact of conditioning regimens, particularly cranial irradiation, on growth velocity is not fully elucidated.
Purpose of the Study:
- To evaluate the growth velocity pattern and growth hormone (GH) secretion in prepubertal patients post-BMT.
- To compare the effects of different conditioning regimens (chemotherapy + TBI vs. chemotherapy + TBI + cranial irradiation) on growth.
- To assess the timing and severity of growth failure in relation to treatment protocols.
Main Methods:
- Retrospective analysis of 18 prepubertal patients (2-11 years) undergoing BMT for oncological/hematological malignancies.
- Patients were divided into two groups based on conditioning regimen: chemotherapy + fractionated TBI (12 Gy) or chemotherapy + TBI + prophylactic cranial irradiation.
- Growth velocity and GH secretion (via pharmacological stimuli) were assessed post-BMT; standard deviation scores (SDS) were calculated.
Main Results:
- Patients receiving prophylactic cranial irradiation showed a significant growth rate decrease by 1 year post-BMT, worsening over 3 years.
- Children treated with chemotherapy and TBI alone exhibited a notable growth rate decrease primarily in the 3rd year post-BMT.
- Mean SDS differed significantly at 1 and 2 years post-BMT between groups due to earlier growth failure in the cranial irradiation group.
Conclusions:
- Prophylactic cranial irradiation significantly exacerbates early growth failure following BMT in prepubertal children.
- The timing of growth deceleration differs between conditioning regimens, impacting long-term growth trajectory.
- Close monitoring of growth and potential GH assessment is crucial for pediatric BMT survivors, especially those with cranial irradiation history.