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)

Abstract

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.

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

“…It is possible that as we move to newer reduced intensity and nonmyeloablative regimens, growth impairment due to GH deficiency following HSCT may only occur rarely as in patients who have significant pre-HSCT radiation exposures. Nearly half of our patients with GH deficiency received r-GH, with a slight effect on adult height, as previously reported [28] (patients who OR, odds ratio; CI, confidence interval. The following parameters were included in the forward stepwise logistic regression models: gender (females vs. males), type of underlying disease, age and Tanner stage (Tanner 2-5 vs. Tanner 1) at HSCT, type of HSCT (autologous vs. allogeneic), type of conditioning therapy (TBI, myeloablative chemotherapy vs. fludarabine/fludarabine with TBI), presence of GVHD (presence vs. absence).…”

Séquelles post-allogreffe de cellules souches hématopoïétiques

“…Croissance Le retard de croissance avec ou sans déficit en hormone de croissance et le risque de réduction de la taille finale sont secondaires à de multiples éléments dont l'état nutritionnel fréquemment altéré, l'âge < 10 ans au moment de la greffe, l'insuffisance gonadique si non substituée, l'irradiation corporelle totale myéloablative, l'irradiation cérébrospinale (risque de déficits hormonaux antéhypophysaires ou au contraire de puberté précoce centrale post-radique avec taille finale compromise), l'hypothyroïdie et la corticothérapie prolongée [13,14]. Il est donc essentiel qu'un suivi de la croissance staturo-pondérale soit effectué (taille, poids et l'indice de masse corporelle) ainsi qu'une évaluation du stade pubertaire (score de Tanner).…”

Growth hormone deficiency: diagnosis and therapy in children

“…Data are expressed as mean ± standard deviation. negative impact of the acute leukaemia-related treatment on the growth of paediatric patients [64]. The dosages of GH used in these studies are not diferent from those used in idiopathic GHD children, ranging from 0.020 to 0.033 mg/kg body weight/day.…”