Final height and gonad function after total body irradiation during childhood

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.

Section: Response To Gh Treatmentmentioning

confidence: 64%

“…ranged from À1.2 to À2 1,2,16,17,23,24 (Table 3). In our study height loss from AL diagnosis to GHD diagnosis was greater in girls and in patients younger than 5 years at the time of cranial irradiation.…”

Section: Discussionmentioning

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

“…Patients treated with TBI at a young age, and who have many years of linear growth ahead of them, are likely to suffer a greater height-loss than those treated at an older age; younger age at the time of SCT has, indeed, invariably been cited as a major risk factor for short stature in pediatric SCT recipients. 3,6,9,[22][23][24][25][26][27][28][29] The final height data reported by seven other studies are summarized in Table 4. 9,[22][23][24][25][26][27] In contrast to the studies by Bakker et al 22,26 and Cohen et al, 9 but in keeping with the findings of others, 23,25 we did not find a significant interaction between gender and final height.…”

Section: Discussionmentioning

confidence: 99%

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

Chemaitilly

Boulad

Heller

et al. 2007

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.

“…We found that early HSCT significantly improved the height of patients in our population, in contrast to other non-MPS IH populations after HSCT. 22,23,34 Our patients were all young (0.5-3.7 years) at the time of HSCT, even so, we still found a greater impact on height for those who were transplanted at an older age, regardless of the age at last height evaluation. This effect is consistent with other studies of children with MPS IH, which also suggested improved outcomes for those children who were transplanted at a younger age.…”

Section: Discussionmentioning

confidence: 66%

Growth and endocrine function in patients with Hurler syndrome after hematopoietic stem cell transplantation

Polgreen

Tolar

Plog

et al. 2008

Short stature is characteristic of Hurler syndrome, or mucopolysaccharidosis type IH (MPS IH). Hematopoietic stem cell transplantation (HSCT) is used to treat children with MPS IH. While HSCT corrects some of the metabolic features of MPS IH, its effects on growth are not well delineated. We investigated growth in patients with MPS IH after HSCT and described accompanying endocrine abnormalities. A cohort of 48 patients with MPS IH who had received HSCT between 1983 and 2005 were included. The prevalence of short stature (height oÀ2 s.d. score, SDS) before HSCT was 9%, and increased to 71% at last follow-up (6.9±5.1 years after HSCT). Short stature was positively associated with increased age at HSCT (P ¼ 0.002) and TBI (P ¼ 0.009). In total, 23% had growth hormone deficiency and/or low insulin-like growth factor-1, one female patient had premature adrenarche, one precocious puberty and 27% had clinical or subclinical hypothyroidism. Growth failure is highly prevalent in children with MPS IH after HSCT. Children who had no TBI exposure and were younger at the time of HSCT had a better height outcome.