Pubertal development and growth after total-body irradiation and bone marrow transplantation for haematological malignancies

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%

“…[3][4][5][6][22][23][24]27,28 Prior cranial radiotherapy has been cited as a significant risk factor for height loss in many reports of The final sitting height s.d.s. in our cohort was severely impaired, with a mean value of À2.2.…”

Section: Discussionmentioning

confidence: 99%

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

Chemaitilly

Boulad

Heller

et al. 2007

“…The 41 boys given BMT were more likely to have altered germ cells with increased plasma FSH (61%), than altered testosterone secretion, which is partially or completely altered with increased LH (24.4%), as shown by others. 12,16 Treatment with testosterone was indicated in only three patients. Testicular volume was lower in those given 10 Gy TBI than in those given 6 Gy TLI, both delivered as a single dose.…”

Section: Discussionmentioning

confidence: 99%

Factors affecting gonadal function after bone marrow transplantation during childhood

Couto-Silva

Trivin

Thibaud

et al. 2001

Summary:Conditioning for bone marrow transplantation (BMT) may alter viability of germ cells and production of gonadal hormones. We analyzed the risk factors for gonadal failure after 12 Gy total body irradiation (TBI) given as six fractions (n = 31, group 1), 10 Gy (one dose) TBI (n = 20, group 2), 6 Gy (one dose) total lymphoid irradiation (TLI, n = 17, group 3) and chemotherapy alone (n = 7, group 4), given at 7.7 ± 0.4 (0.6-13.6) years. Among the 34 girls, seven (20.6%) had normal ovarian function with regular spontaneous menstruation and normal plasma follicle-stimulating (FSH) and luteinizing (LH) hormones, five (14.7%) had partial ovarian failure with regular menstruation but increased FSH and/or LH, and 22 (64.7%) had complete ovarian failure. The 24 girls with chronological and bone ages Ͼ13 years included similar percentages, with increased FSH or LH in all four groups. There was a positive correlation between age at BMT and FSH (r = 0.54, P Ͻ 0.01), but not with LH, and between FSH and LH (r = 0.8, P = 0.0003). Plasma FSH concentrations had returned to normal spontaneously in six cases, and those of LH in two cases. Among the 41 boys, 16 (39%) had normal testicular function and 25 (61%) had tubular failure and increased FSH. Of these, 10 also had Leydig cell failure (three complete and seven partial). The 18 boys with chronological and bone ages Ͼ15 years included similar percentages with increased FSH or LH in groups 1 to 3, and testicular volume was significantly lower in group 2 than in group 3 (P = 0.008). There was no correlation between age at BMT and FSH, LH or testosterone, but there was a negative correlation between FSH and inhibin B (rho = −0.87, P Ͻ 0.003). We conclude that girls are more likely to suffer ovarian failure the older they are at BMT, and that early ovarian recovery is possible. Keywords: bone marrow transplantation; fertility; inhibin; irradiation; ovary; testis Conditioning for bone marrow transplantation (BMT) may alter the production of gonadal hormones (estradiol and progesterone in girls, testosterone in boys) and the viability of germ cells. 1-3 Gonadal failure results in incomplete sexual development and growth at puberty, and sterility in adulthood. Gonadal hormones are required for the development of secondary sexual characteristics, and for the growth acceleration which normally occurs at puberty.The risk factors for gonadal failure in patients undergoing BMT are difficult to analyze because of the variety of conditioning regimens used, and the possibility of gonadal recovery. 4 This study analyzes the expression and frequency of gonadal failure in both sexes according to the conditioning protocol, and the significance of the age during childhood at which BMT is carried out. We also measured plasma inhibin B concentrations as an additional marker of tubular function in these young patients where semen analysis is not possible. PatientsThe gonadal function of 75 patients (34 girls and 41 boys) who received a BMT during childhood, and who were aged more than 10 years ...

“…of the general population, and that the type of transplantation, graft-versus-host disease, growth hormone (GH) or steroid treatment did not influence final height. 2 Bakker et al 7 also reported that male gender and a young age at the time of HCT were the only factors with an independent negative effect on longitudinal growth, whereas TBI dose (5-12 Grays (Gy)), age at the onset of puberty and the need to induce puberty did not influence growth.…”

Section: Introductionmentioning

confidence: 99%

Final height and gonad function after total body irradiation during childhood

Couto-Silva

Trivin

Esperou

et al. 2006

Short stature and gonad failure can be a side effect of total body irradiation (TBI). The purpose of the study was to evaluate the factors influencing final height and gonad function after TBI. Fifty young adults given TBI during childhood were included. Twenty-seven had been treated with growth hormone (GH). Those given single 10 Grays (Gy) or fractionated 12 Gy TBI had similar characteristics, GH peaks, final heights and gonad function. After the end of GH treatment, 11/20 patients evaluated had GH peak 410 lg/l. Final height was oÀ2 s.d. in 29 (58%). The height loss between TBI and final height (2.471.1 s.d.) was greater in those who were younger when irradiated (Po0.0001). When the GH-treated and -untreated patients were analyzed separately, this loss was correlated with the age at TBI at 4-8 years for the GHtreated and at 6-8 years for the untreated. Boys showed negative correlations between testicular volume and plasma follicle-stimulating hormone (FSH, P ¼ 0.0008) and between plasma FSH and inhibin B (P ¼ 0.005) concentrations. We concluded that the indications for GH treatment should be mainly based on the age at irradiation, taking into account the GH peak. The plasma FSH and inhibin B concentrations may predict sperm function.