Final adult height of patients who received hematopoietic cell transplantation in childhood

Abstract

Growth impairment and growth hormone (GH) deficiency are complications after total body irradiation (TBI) and hematopoietic cell transplantation (HCT). To determine the impact of GH therapy on growth, the final heights of 90 GH-deficient children who underwent fractionated TBI and HCT for malignancy were evaluated. Changes in height standard deviation (SD) from the diagnosis of GH deficiency to the achievement of final height were compared among 42 who did and 48 who did not receive GH therapy. At HCT, GHtreated patients were younger (P ‫؍‬ .001), more likely to have undergone central nervous system irradiation (P ‫؍‬ .007), and shorter (P ‫؍‬ .005) than patients who did not receive GH therapy. After HCT, GH deficiency was diagnosed at 1.5 years (range, 0.8-9.5 years) for GH-treated and 1.2 years (range, 0.9-8.8 years) for nontreated patients. GH therapy was associated with significantly improved final height in children younger than 10 years at HCT (P ‫؍‬ .0001), but GH therapy did not impact the growth of older children.

Autologous purified peripheral blood SCT in childhood low-risk relapsed ALL

“…Late effects were as expected in transplantation after conditioning with a TBI-containing conditioning regimen. [43][44][45][46] This study compares favorably with previous experiences using chemotherapy and historical unmanipulated autografting, reporting EFS ranging from 33 to 56% for CNS relapses, 69% for any extramedullary relapse and from 41 to 61% for late relapses. [12][13][14][15][16][17][18][19][20][21][22][23][24][25] In a previous matched-pair analysis for late medullary relapses, autologous transplantation, reporting an EFS of 41%, was of no benefit, compared with chemotherapy.…”

“…Infertility and an increased incidence of endocrinological problems, growth impairment, early cataracts and second malignancies are expected compared with chemotherapy-treated children. [43][44][45][46]54,[58][59][60] It is always difficult to counterbalance the advantage of higher efficacy with the draw backs of long-term toxicity. Lower complication rates are expected for non-transplanted children, even though their treatment invariably includes cranial irradiation, which also increases the risk of brain tumors, and testicular irradiation or orchiectomy, in the event of testicular relapse.…”

“…1.12; range À2.82 to þ 1.65), with 25% of the patients below the 10th percentile and 13% below the 3rd one ( Figure 4). [43][44][45]54 Older children and adolescents (X11 years of age at transplant) were more likely to report normal growth whereas younger children (transplantation o11 years of age) reported the lowest percentiles. Ten of the 15 patients who were in post-puberal age at the time of the last visit were diagnosed with hypergonadotropic hypogonadism, which required hormonal replacement treatment in 7 of them (47%); 3 patients (15%) were diagnosed with hypothyroidism requiring hormonal replacement therapy, and 1 experienced a self-limiting autoimmune thyroiditis; 6 patients (30%) were diagnosed with a cataract, which required surgical treatment in two cases to date; 5 patients showed a very mild impairment at pulmonary function tests; 1 child had developed bilateral …”

“…[43][44][45][46]52,53 Lymphocyte subset counts achieved normal ranges at the end of the first year after transplantation ( Figure 3). 41 Growth evaluations showed that mean height z-score at the time of transplant (mean 0.0; s.d.…”

“…41 Long-term follow-up visits were planned in surviving patients to assess general health, and in particular growth and endocrinological issues. [41][42][43][44][45][46] Statistical analysis Results of the descriptive analysis are reported as mean and standard deviation or median and range, as appropriate. Height measurements are expressed as z-scores, indicating the extent of standard deviations, for each observation, either above or below the age-and gender-adjusted mean for the normal population.…”