Insulin-like growth factor-I and insulin-like growth factor binding protein-3 during maintenance chemotherapy of acute lymphoblastic leukemia in children
M. Schmiegelow et al., Insulin-like growth factor-I and insulin-like growth factor binding protein-3 during maintenance chemotherapy of acute lymphoblastic leukemia in children, J PED H ONC, 21(4), 1999, pp. 268-273
Purpose: To assess the effect of maintenance chemotherapy (MT) on growth fa
ctors and growth in children with acute lymphoblastic leukemia (ALL).
Patients and Methods: Twenty-one children (10 girls, 11 boys) with standard
risk pre-B ALL treated with chemotherapy had serum insulin-like growth fac
tor-I (IGF-I), serum IGF binding protein-3 (IGFBP-3) levels, and linear gro
wth and weight data measured every 3 months during MT. The levels of the cy
totoxic metabolites of methotrexate (MTX) and 6-mercaptopurine (6MP) (i.e.,
erythrocyte MTX polyglutamates [E-MTX], and erythrocyte B-thioguanine nucl
eotides [E-6TGN]), s-aminotransferases, and white blood counts (WBC) were m
easured at least monthly.
Results: At the beginning of MT, the median IGF-I standard deviation scores
(SDS) and IGFBP-3 SDS were -0.52 and -0.09, respectively, which declined d
uring NIT to -1.67 (P < 0.001) and -1.82 (P < 0.001), respectively. At the
time of diagnosis, the median height SDS was -0.4, which declined during MT
to a median height SDS of -0.9 at cessation of therapy. No significant cor
relations were found between growth factor levels, growth and body mass ind
ex (BMI) versus the doses of MTX. and 6MP, E-MTX, E-6TGN, s-aminotransferas
es, or WBC.
Conclusions: A significant decline in IGF-I, IGFBP-3, and growth retardatio
n may not be directly related to the treatment intensity during MT.