MYELODYSPLASTIC SYNDROME DURING RECOMBINANT HUMAN GROWTH-HORMONE SUPPLEMENTATION AFTER TREATMENT FOR NEUROBLASTOMA

At 6 months of age, the patient was diagnosed as having neuroblastoma stage IV and was given the chemotherapy, local irradiation, and operat ion. The treatment was completed in September 1989. In 1992, at 6 year s of age, her height was -3 SD and growth hormone secretion was depres sed. She had been supplemented with recombinant human growth hormone ( rhGH). Because the white blood cell counts began to decrease gradually in 1993, the rhGH therapy was interrupted on January 19, 1994. The rh GH supplement was resumed after a 3-month interval because of the pare nt's desire. Pancytopenia soon became apparent. She was diagnosed as h aving myelodysplastic syndrome (MDS) as a refractory anemia with an ex cess of blasts in transformation with monosomy 7. The rhGH therapy was interrupted again, without any improvement of the MDS. In culture stu dies, neither rhGH nor insulin-like growth factor-1 stimulated prolife ration of her bone marrow cells. These data suggested that the treatme nt with rhGH after the chemotherapy played some role in the promotion, but not acceleration, of the MDS.