Growth in children with poor-risk neuroblastoma after regimens with or without total body irradiation in preparation for autologous bone marrow transplantation
L. Hovi et al., Growth in children with poor-risk neuroblastoma after regimens with or without total body irradiation in preparation for autologous bone marrow transplantation, BONE MAR TR, 24(10), 1999, pp. 1131-1136
Citations number
24
Categorie Soggetti
Hematology,"Medical Research Diagnosis & Treatment
Impaired growth after TBI prior to BMT has been a constant finding in child
ren with leukemia. The growth of poor-risk neuroblastoma (NBL) survivors tr
eated with myeloablative preparative regimens and ABMT at the Hospital for
Children and Adolescents, University of Helsinki, since 1982 is reported. T
wo separate groups were analyzed: (1) The TBI- patients (n = 15) were condi
tioned with high-dose chemotherapy only. They had been treated at the age o
f 1.0-6.3 (mean 3.0) years and the post-ABMT follow-up time was 1.5-14.5 (m
ean 7.7) years. (2) The TBI+ patients (n = 16) had received TBI in addition
to high-dose chemotherapy, They had been treated at the age of 1.3-4.8 (me
an 3.0) years, and the post-ABMT follow-up time was 1.5-8.0 (mean 4.7) year
s. The height standard deviation score (SDS) was similar for the two groups
at the time of diagnosis, -0.3 +/- 1.2 (mean +/- s.d.), and at the time of
ABMT, -0.7 +/- 1,1. After transplantation, the height SDS continued to dec
rease in the TBI+ group, the mean being -2.0 SDS at 5 years after ABMT. In
the TBI- group, the mean height SDS remained within -0.7 to -0.9 to the 10
years of follow-up. Five patients received growth hormone (GH) therapy star
ting 2-6 years after ABMT. They all had low GH secretion in provocative tes
ts. All showed some response to GH therapy, The mean height SDS increased 0
.4 SDS during the 3 years following the start of GH therapy, while in the u
ntreated patients a decrease of 0.8 SDS during the corresponding time (P =
0.009) was observed. We conclude that NBL patients grow poorly following AB
MT when TBI is included in the conditioning regimen, but close to normally
when treated without TBI, The need for GH therapy should be evaluated early
to avoid an unnecessary decrease in final height.