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Growth after bone marrow transplantation in young children conditioned with chemotherapy alone
L Adan1, M L de Lanversin, C Thalassinos
1Pediatric Endocrinology, Université Paris V et Hôpital Necker- Enfants Malades, Assistance Publique-Hôpitaux de Paris, France.
Insights
Children undergoing bone marrow transplantation (BMT) may experience short stature. Post-BMT complications, not chemotherapy conditioning alone, hinder catch-up growth and insulin-like growth factor I (IGFI) increase in children.
Area of Science:
- Pediatric Endocrinology
- Hematology
- Oncology
Background:
- Short stature is a known complication of bone marrow transplantation (BMT).
- Growth impairment can result from conditioning regimens and/or post-transplant complications.
- Understanding factors affecting growth post-BMT is crucial for pediatric patient care.
Purpose of the Study:
- To evaluate the impact of chemotherapy conditioning and BMT complications on growth in children.
- To determine if chemotherapy alone prevents catch-up growth after BMT.
- To investigate the role of post-BMT complications in growth failure.
Main Methods:
- Study included 30 children conditioned for BMT using chemotherapy (cyclophosphamide and busulfan).
- Children were divided into two groups based on the presence (Group 2) or absence (Group 1) of serious/prolonged post-BMT complications.
- Growth and plasma insulin-like growth factor I (IGFI) levels were assessed 2 years post-BMT.
Main Results:
- Group 1 (no complications) showed significant catch-up growth and increased plasma IGFI levels 2 years post-BMT.
- Group 2 (with complications) did not exhibit significant growth or increased plasma IGFI levels.
- Initial growth retardation due to disease did not differ between groups at the time of BMT.
Conclusions:
- Chemotherapy conditioning alone does not preclude catch-up growth in young children post-BMT.
- Post-BMT complications are the primary cause of impaired catch-up growth.
- BMT complications appear to inhibit the increase in plasma IGFI, thereby preventing catch-up growth.
Abstract:
Short stature is a potential side-effect of BMT, brought about by the conditioning protocol and/or the complications of BMT. This study evaluates the effects of conditioning by chemotherapy, and BMT complications on growth. Thirty children conditioned for BMT by chemotherapy alone (cyclophosphamide and busulfan) were classified according to the occurrence of serious or prolonged complications after BMT: group 1 (n = 12) had no complication, while group 2 (n = 18) did. Fifteen of them were severely growth retarded (< or = -2 s.d.) at BMT, because of their initial disease. At the time of BMT, the two groups had similar ages (1.0 +/- 0.2, s.e.m. year, in group 1 and 1.7 +/- 0.5 year in group 2), height (-1.7 +/- 0.5; -1.8 +/- 0.3 s.d.) and plasma insulin-like growth factor I (IGFI) levels (0.3 +/- 0.1 U/ml in both). Group I grew significantly and their plasma IGFI increased but group 2 did not, as assessed 2 years post-BMT. We conclude that conditioning with chemotherapy alone does not prevent the catch-up growth induced by BMT in young children; the lack of catch-up growth is due to complications occurring after BMT, and the change in plasma IGFI suggests that complications of BMT prevent any increase in plasma IGFI, and thereby catch-up growth.