Pubertal development and growth after total-body irradiation and bone marrow transplantation for haematological malignancies

Pubertal development after total-body irradiation (TBI) was investigated in 40 children (21 boys) treated with allogeneic bone marrow transplantation (BMT) for haematological malignancies at a mean age of 11.3 years. The mean age at the last visit was 19.0 years, Twenty-five patients (15 boys) were prepubertal at BMT. Data on secondary sexual characteristics, the pituitary -gonadal axis and longitudinal growth were retrospectively collected from t he medical records. In boys not receiving additional testicular irradiation (n = 19), penile growth and pubic hair development was normal and all had serum testosterone levels within the adult range. The majority of them, how ever, had incidental elevations of LH, suggesting minor Leydig cell damage. Testicular volume at last measurement was small (mean: 10.5 ml) and serum FSH levels were elevated in all boys, with normalisation in only one, sugge sting severe impairment of reproductive gonadal function. Of the ten girls who received BMT before puberty, six had a spontaneous onset of puberty and menarche; the four other girls needed hormonal substitution therapy. Recov ery of gonadal function after cessation of substitution was seen in one gir l, who became pregnant but had a spontaneous abortion. Decrease in height S DS was seen in the majority of patients and was positively correlated with male gender and lower age at the time of BMT. Conclusion Careful monitoring of both gonadal function and growth after bon e marrow transplantation and total body irradiation is warranted in order t o detect disturbances early and ensure normal pubertal development in child ren treated for haematological malignancies.