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Myelodysplastic syndrome during recombinant human growth hormone supplementation after treatment for neuroblastoma
M Miyabayashi1, T Higuchi, T Mori
1Department of Pediatrics, Shinshu University School of Medicine, Matsumoto, Japan.
Insights
Recombinant human growth hormone (rhGH) therapy in a neuroblastoma survivor may have promoted myelodysplastic syndrome (MDS). Further research is needed to understand the relationship between rhGH treatment and MDS development.
Area of Science:
- Pediatric Oncology
- Hematology
- Endocrinology
Background:
- A patient diagnosed with neuroblastoma stage IV at 6 months received chemotherapy, irradiation, and surgery.
- Following treatment, the patient exhibited growth deficiency and depressed growth hormone secretion, necessitating recombinant human growth hormone (rhGH) supplementation.
Observation:
- rhGH therapy was initiated in 1992 and interrupted in 1994 due to decreasing white blood cell counts.
- rhGH supplementation was resumed, leading to pancytopenia and a diagnosis of myelodysplastic syndrome (MDS) with monosomy 7.
- In vitro studies showed rhGH and insulin-like growth factor-1 did not stimulate bone marrow cell proliferation.
Findings:
- The development of myelodysplastic syndrome (MDS) in this patient occurred after rhGH therapy initiation.
- rhGH treatment appeared to promote MDS development rather than accelerate its progression.
Implications:
- This case suggests a potential role for rhGH in the promotion of MDS in susceptible individuals, particularly after prior cancer treatment.
- Further investigation is warranted to elucidate the mechanisms underlying rhGH's potential influence on MDS pathogenesis.
Abstract:
At 6 months of age, the patient was diagnosed as having neuroblastoma stage IV and was given the chemotherapy, local irradiation, and operation. The treatment was completed in September 1989. In 1992, at 6 years of age, her height was -3 SD and growth hormone secretion was depressed. She had been supplemented with recombinant human growth hormone (rhGH). Because the white blood cell counts began to decrease gradually in 1993, the rhGH therapy was interrupted on January 19, 1994. The rhGH supplement was resumed after a 3-month interval because of the parent's desire. Pancytopenia soon became apparent. She was diagnosed as having myelodysplastic syndrome (MDS) as a refractory anemia with an excess of blasts in transformation with monosomy 7. The rhGH therapy was interrupted again, without any improvement of the MDS. In culture studies, neither rhGH nor insulin-like growth factor-1 stimulated proliferation of her bone marrow cells. These data suggested that the treatment with rhGH after the chemotherapy played some role in the promotion, but not acceleration, of the MDS.
