Contribution of growth hormone deficiency to the growth failure that follows bone marrow transplantation

Impaired linear growth has been shown to occur in individuals treated during childhood with single-dose and fractionated total body irradiation (TBI) before stem cell transplantation. Our objective was to describe the final heights attained and patient/treatment factors correlating with final height in a cohort of childhood cancer survivors treated with hyperfractionated TBI (total dose 1375 or 1500 cGy). Thirty individuals (18 men In conclusion, treatment with hyperfractionated TBI is associated with a reduction in standing height and an even greater reduction in sitting height. Final height after hyperfractionated TBI was similar to that reported after fractionated TBI.

Section: Discussionmentioning

confidence: 99%

Final height in pediatric patients after hyperfractionated total body irradiation and stem cell transplantation

Chemaitilly

Boulad

Heller

et al. 2007

“…Three patients (3.3%) were diagnosed with type II diabetes mellitus and three (3.3%) with IGT at a mean age of 21.576.1 years (range, [15][16][17][18][19][20][21][22][23][24][25][26][27][28]. A BMI-SDS of o2 was noted in all three patients with diabetes and in two of the three patients with IGT.…”

Section: Diabetes Mellitus and Parameters Of Metabolic Syndromementioning

confidence: 99%

“…Growth hormone treatment after BMT has usually been reported to result in increase in growth velocity, albeit a smaller one than in children with idiopathic GH deficiency, which is probably caused by the lesions induced by TBI. 25 All our patients diagnosed with GH deficiency were treated with recombinant growth hormone (rGH), which had a beneficial effect on growth. Based on our results, we suggest that rGH be administered to children with a decreased growth rate and low GH values on stimulation tests, presuming that other hormones necessary for optimal growth are adequately replaced.…”

Section: Endocrine Dysfunction After Bmt During Childhood S Shalitin mentioning

confidence: 99%

Endocrine dysfunction and parameters of the metabolic syndrome after bone marrow transplantation during childhood and adolescence

Shalitin

Phillip

Stein

et al. 2006

Endocrine dysfunction and parameters of metabolic syndrome were assessed in 91 patients aged 4.3-32.5 years who underwent allogeneic or autologous BMT in childhood. Final short stature, found in five of the 35 patients who attained final height, was associated with the underlying disease (specifically, Fanconi anemia) (P ¼ 0.0013), previous cranial irradiation (P ¼ 0.0007), type of conditioning irradiation (Po0.05) and allogeneic BMT (P ¼ 0.05). Growth hormone deficiency (n ¼ 10) was associated with previous cranial irradiation (Po0.005) and conditioning total body irradiation (Po0.001). Twelve patients had primary hypothyroidism, one had hyperthyroidism and one papillary thyroid carcinoma. Hypothyroidism was associated with neck/mediastinal (Po0.005) and conditioning irradiation (Po0.05). Primary gonadal failure was found in 24 of the mature patients (62.5% females). Hypogonadism was associated with the underlying disease (especially hematological malignancies) (Po0.05), pretransplant treatment (Po0.05), irradiation conditioning (Po0.001), older age (Po0.005) and advanced pubertal stage at BMT (Po0.05). Obesity (body mass index 42 s.d.) was found in 4.4% and type II diabetes and impaired glucose tolerance in 3.3% each. Dyslipidemia was found in 27.9% of the 43 patients tested. These findings emphasize the need for long-term follow-up of endocrine and metabolic parameters in young patients after BMT in order to offer proper treatment and improve quality of life.

“…The growth and growth hormone (GH) deficiency have been observed in children after haematopoietic SCT (HSCT) with TBI [1][2][3][4][5] and those previously undergoing central nervous system irradiation (CI) to treat acute leukaemia (AL). [1][2][3][5][6][7] Conditioning regimen chemotherapy and irradiation are often superimposed on the 'standard' therapies, which may compromise pubertal development and final height (FH) in their own right.…”

Section: Introductionmentioning

confidence: 99%

“…[1][2][3][5][6][7] Conditioning regimen chemotherapy and irradiation are often superimposed on the 'standard' therapies, which may compromise pubertal development and final height (FH) in their own right. 8 Also, with the increasing number of survivors and duration of follow-up, patients may experience a significant loss of height potential.…”

Section: Introductionmentioning

confidence: 99%

Growth hormone treatment impact on growth rate and final height of patients who received HSCT with TBI or/and cranial irradiation in childhood: a report from the French Leukaemia Long-Term Follow-Up Study (LEA)

Isfan

Kanold

Merlin

et al. 2011

The literature contains a substantial amount of information about factors that adversely influence the linear growth in up to 85% of patients undergoing haematopoietic SCT (HSCT) with TBI and/or cranial irradiation (CI) for acute leukaemia (AL). By contrast, only a few studies have evaluated the impact of growth hormone (GH) therapy on growth rate and final height (FH) in these children. We evaluated growth rates during the preand post-transplant periods to FH in a group of 25 children treated with HSCT (n ¼ 22), TBI (n ¼ 21) or/and CI (n ¼ 8) for AL and receiving GH therapy. At the start of GH treatment, the median height Z-score was À2.19 (À3.95 to 0.02), significantly lower than at AL diagnosis (Po0.001). Overall height gain from start of GH treatment to FH was 0.59Z (À2.72 to 2.93) with a median height Z-score at FH of À1.35 (À5.35 to 0.27). This overall height gain effect was greater in girls than in boys (P ¼ 0.04). The number of children with heights in the reference population range was greater after than before GH therapy (P ¼ 0.07). At FH the GVHD and GH treatments lasting o2 years were associated with shorter FH (P ¼ 0.02 and 0.05). We found a measurable beneficial effect of GH treatment on growth up to FH.