Height growth during adolescence and final height after haematopoietic SCT for childhood acute leukaemia: the impact of a conditioning regimen with BU or TBI

Abstract

We compared the impact of a conditioning regimen with BU (n=16) or fractionated TBI (n=42) on height growth during adolescence and final height (FH), in 58 adults transplanted for acute leukaemia before adolescence (younger than 9 for girls and 11 for boys, and prepubertal). Heights were measured at three key periods, that is, transplantation, before adolescence, and FH, and compared using height standard deviation score (SDS) and cumulative change in SDS. The influence of the conditioning regimen was assessed using multiple linear regression and adjusting for gender, central nervous system irradiation, age and leukaemia status at transplant and type of transplantation. Overall mean height SDS was near normal at transplantation and before adolescence (0.2+/-0.1 and -0.2+/-0.1, respectively), but decreased to -1.6+/-0.1 at FH. There were significant differences between the TBI and BU groups when comparing FH SDS (-1.8+/-0.2 vs -0.8+/-0.2, P=0.001), mean change in height SDS from transplantation to FH (-2+/-0.1 vs -1.1+/-0.2, P=0.002) and mean change in height SDS during adolescence (-1.6+/-0.1 vs -0.7+/-0.2, P=0.003). We conclude that preparations involving BU, although less toxic than TBI-containing regimens, also have adverse effects on growth, predominantly during adolescence.

Endocrine and Metabolic Disturbances in Survivors of Hematopoietic Stem Cell Transplantation in Childhood and Adolescence

“…DOI: 10.1159/000486034 In our cohort, SS occurred in patients conditioned with busulfan-containing regimens at a rate similar to that seen following TBI, as reported by Bernard et al [25]. Although busulfan is less toxic than TBI-containing regimens, it may adversely affect growth by its toxic effect on gonads leading to impaired gonadal function and dysregulation of interactions between sex hormones and GH, with subsequent altered peripubertal growth.…”

Health status of childhood leukemia survivors who received hematopoietic cell transplantation after BU or TBI: an LEA study

“…Besides the well-known damage to puberty and gonadal function, 3 we confirm a consequent impact on growth, as previously noted. 28 Moreover, BU increased widely the risk of overweight (OR ¼ 3.9). Previous studies have reported the changes in BMI (over-or underweight) induced by HSCT.…”

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)

“…The literature contains a number of studies about factors that adversely affect growth in children treated for AL (age at the time of AL treatment, irradiation dose and fraction size, and so on). 3,6,[9][10][11][12][13][14] By contrast, only a few studies have evaluated the impact of GH replacement therapy on growth rate and FH in these children. 1,2,7,[15][16][17] A better understanding of the factors influencing response to GH will allow the identification of patients who can benefit from appropriate hormonal replacement therapy.…”

“…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.…”

“…[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.…”