Growth Velocity in Pediatric Bone Marrow Transplantation: Significance of Donor Type and Treatment Factors

Abstract

Children who have undergone bone marrow transplantation (BMT) often have decreased growth. Growth is a multifactorial process, and the factors that influence growth after BMT are not completely understood. The authors hypothesized that donor type may be a factor influencing growth. Sixty-five children and adolescents who underwent BMT (32 related matched, 33 unrelated matched) were evaluated. Growth velocity (height standard deviation) was assessed prior to and 2 years following BMT. The results indicated that children and adolescents who underwent unrelated matched transplants had lower growth velocity (P < .059) than those with related matched transplants. Those who received the standard conditioning regimen that included total body irradiation (TBI) had a significantly lower growth velocity (P< .045) than those with chemotherapy-only regimens. Significant correlates of growth velocity included younger age at BMT and pre-BMT growth velocity. Thus, donor type, age at BMT, prior treatment, and BMT conditioning regimens that include TBI may all affect growth post-BMT. Careful monitoring of growth velocity is required for patients who have received an unrelated donor BMT.

Reviewing the Follow-up Care of Pediatric Patients’ Status Post–Hematopoietic Stem Cell Transplantation for the Primary Care Pediatrician

“…HSCT usually has an impact on all these factors and, thus, patients are at risk for alterations in growth. 24 In a prospective study among 49 pediatric HSCT patients, the most profound loss of bone mineral density (BMD) was within the first 6 months following HSCT, similar to what has been reported in adults. In this study, some children showed recovery; however, 33% remained osteopenic and 19% osteoporotic at 1 year following HSCT.…”