GROWTH AND GROWTH-HORMONE SECRETION AFTER TREATMENT FOR CHILDHOOD NON-HODGKINS-LYMPHOMA

The aim of this study was to evaluate the growth and growth hormone IC H) secretion, as assessed by the rate and pattern of secretion, in pat ients in remission from non-Hodgkin's lymphoma (NHL) who had been trea ted with corticosteroids and intense chemotherapy. None of the patient s had received cranial irradiation. Twelve children were investigated yearly by taking 24-hour GH profiles starting 1 year from the time of diagnosis. The mean age at onset of the disease was 7.5 years. Another 12 young adults were studied in a cross-sectional manner 4.1-21.3 yea rs (mean, 9.0 years) after diagnosis of NHL. The mean age at onset of the disease was 10.7 years. The median height velocity was significant ly decreased during the 1 st year following diagnosis (standard deviat ion scores [SDS] -0.15, P<.001), especially during the first 3 months (SDS -0.75, P<.001) when the most intense treatment was given. During the 2nd year height velocity was still somewhat reduced (SDS -0.13, P< .001). However, there was no reduction in final attained height. Spont aneous CH secretion, in terms of both secretory rate and pulsatile pat tern, was evaluated by measuring integrated GH concentrations in 20-mi nute blood samples collected over a 24-hour period. The plasma GH conc entrations were transformed into GH secretion rates by means of a deco nvolution technique. Fourier time series analysis was applied to deter mine possible disturbances of rhythmicity of the GH secretion. The GH secretion rate and the pulsatile pattern of secretion in the NHL patie nts were similar to those of the reference population of pubertal matc hed healthy controls. There was no influence of the age at diagnosis o r of the time from diagnosis of NHL on the CH secretion rate. Growth i mpairment in children with a malignant disease treated only with stero ids and chemotherapy is therefore probably not caused by disturbed GH secretion, but rather by direct interference with bone growth of the c ytotoxic drugs used. There was no significant influence on weight gain during the treatment period so an indirect effect of che chemotherapy on bone growth through interference with adequate nutrition seems unl ikely. However, GH secretion was not evaluated during the period of gr owth retardation, and therefore a transient deficiency was not exclude d. (C) 1997 Wiley-Liss, Inc.