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Growth and growth hormone secretion in children after bone marrow transplantation
O Shinohara1, C Kubota, T Hinohara
1Department of Pediatrics, Tokai University School of Medicine, Kanagawa, Japan.
Insights
Bone marrow transplantation (BMT) can impair linear growth in children, affecting over half of survivors. However, growth hormone (GH) secretion levels do not predict future growth patterns post-BMT.
Area of Science:
- Pediatric Endocrinology
- Hematology
- Transplantation Medicine
Background:
- Long-term complications of bone marrow transplantation (BMT) are a significant concern for survivors.
- Advances in BMT have increased the number of long-term survivors, necessitating research into post-transplant sequelae.
Purpose of the Study:
- To evaluate linear growth and growth hormone (GH) secretion in children surviving more than 3 years after BMT.
- To identify factors contributing to impaired linear growth post-BMT.
- To determine if GH secretory capacity predicts growth patterns in pediatric BMT survivors.
Main Methods:
- Assessed linear growth using height standard deviation scores (SDS) in 25 pediatric BMT survivors.
- Evaluated GH secretion through serial testing, including insulin-induced hypoglycemia.
- Analyzed potential influencing factors such as age at BMT, disease type, preconditioning regimen, and graft-versus-host disease.
Main Results:
- Impaired linear growth (SDS change > -1.0) was observed in 56% of patients (14/25).
- Severe growth suppression (SDS decrease > -2.0) occurred in 4 children; moderate reduction (SDS -1.0 to -2.0) in 10.
- Early age at BMT correlated with recovery of normal height velocity.
- GH secretory capacity 1 year post-BMT did not predict impaired growth.
Conclusions:
- Impaired linear growth is a common sequela in long-term pediatric BMT survivors.
- Age at transplantation appears to influence growth recovery.
- Growth hormone secretory status is not a reliable predictor of growth trajectory in these patients.
Abstract:
Long-term sequelae of bone marrow transplantation (BMT) are a major concern among long-term survivors since the procedure has been considerably developed over the past decade. In this study, linear growth and growth hormone (GH) secretion were evaluated in 25 children (14 males and 11 females) with various neoplastic or non-neoplastic hematological disorders who had survived for more than 3 years after BMT. Impaired linear growth after BMT, as defined by a change in height standard deviation score (SDS) by more than -1.0 SD, was observed in 14 patients (56%). Four children showed severe growth suppression with a decrease in SD score by more than 2.0, and 10 exhibited a moderate reduction by between 1.0 and 2.0 SD. A recovery of normal height velocity was observed in those who had received BMT at a younger age. The type of disease, a difference in preconditioning regimen, the presence of chronic graft-versus-host disease or a GH secretory capacity 1 year after BMT were not contributing factors for impaired growth. A serial examination of GH secretion with insulin-induced hypoglycemia demonstrated that poor GH secretion was not necessarily a prerequisite for impaired growth. These results indicate that the secretory status of GH does not predict the future growth pattern of children who received BMT.