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Growth and development following marrow transplantation for leukemia
JE Sanders, S Pritchard, P Mahoney, D Amos, CD Buckner, RP Witherspoon, HJ Deeg, KC Doney, KM Sullivan and FR Appelbaum
One hundred forty-two patients between the ages of 1 and 17 years who
survived disease-free more than 1 year after marrow transplantation for
hematologic malignancy had growth and development evaluations from one to
14 years posttransplant (median 4 years). Prior to transplant all children
received multiagent chemotherapy and 55 also received central nervous
system irradiation, but none had growth and development evaluations. Marrow
transplant preparation included high-dose chemotherapy and total body
irradiation (TBI) given as a single dose of 9.2 to 10.0 Gy (79 patients) or
as fractionated doses of 2.0 to 2.25 Gy/d for six to seven days (63
patients). After transplant abnormal thyroid function was present in 39%.
Stimulated 11-desoxycortisol levels were subnormal in 24% of patients
evaluated. Growth hormone (GH) deficiency was present in 17 of 25 children
who received previous cranial irradiation. Partial GH deficiency was
present in 4 of 25 who received previous cranial irradiation and in 6 of 18
who had not received cranial irradiation. Height velocity was decreased in
all patients. After transplant, height was significantly influenced by
chronic graft-v-host disease and single-dose TBI. Sixty-eight percent had
delayed development of secondary sexual characteristics. Gonadal failure
occurred in nearly all who were postpubertal at transplant. While it is not
possible to determine how many of these endocrine abnormalities occurred as
a result of treatment administered prior to transplantation, these data do
demonstrate that children who become long-term survivors after marrow
transplantation for hematologic malignancy have endocrine abnormalities
that adversely affect growth and development.
Volume 68,
Issue 5,
pp. 1129-1135,
11/01/1986
Copyright © 1986 by The American Society of Hematology
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