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Blood, Vol. 93 No. 12 (June 15), 1999:
pp. 4109-4115
Final Height of Patients Who Underwent Bone Marrow Transplantation
for Hematological Disorders During Childhood: A Study by the
Working Party for Late Effects-EBMT
Amnon Cohen,
Attilio Rovelli,
Boudewijn Bakker,
Cornelio Uderzo,
Maria-Teresa van Lint,
Helene Esperou,
Alberto Gaiero,
Alison D. Leiper,
Roland Dopfer,
Jean Yves Cahn,
Franco Merlo,
Hans J. Kolb, and
Gerard Socié on behalf of the EBMT Late-Effects Working Party
From the University Department of Pediatrics, Gaslini Institute,
Children's Hospital, Genoa, Italy; the Clinica Pediatrica, San Gerardo
Hospital, Monza, Italy; the Department of Pediatrics, Leiden University
Medical Center, Leiden, The Netherlands; the Centro Trapianti di
Midollo, San Martino Hospital, Genoa, Italy; the Service
d'Hematologie-Greffe de Moelle, Hòpital Saint Louis, Paris,
France; the Department Of Haematology and Oncology, Great Ormond Street
Hospital for Children, NHS Trust, London, UK; the Department of
Pediatrics University Hospital, Tubingen, Germany; the Service
D'Hematologie Hospital Jean Minjoz, Besancon, France; the Department
of Environmental Epidemiology and Biostatistics, National Cancer
Institute, Genoa, Italy; and Medical Klinik III, Klinikum Grosshadern,
Munchen, Germany.
Few data are available on the long-term effect of bone marrow
transplantation (BMT) on growth. This study examines those factors that
play a role in the final height outcome of patients who underwent BMT
during childhood. Data on 181 of 230 patients with aplastic anemia,
leukemias, and lymphomas who had BMT before puberty (mean age, 9.8 ± 2.6 years) and who had reached their final height were analyzed. An
overall decrease in final height standard deviation score (SDS) value
was found compared with the height at BMT (P < 107) and with the genetic height (P < 107). Girls did better than boys, and the younger in age
the person was at time of BMT, the greater the loss in
height. Previous cranial irradiation + single-dose total
body irradiation (TBI) caused the greatest negative effect
on final height achievement (P < 104).
Fractionation of TBI reduces this effect significantly and conditioning
with busulfan and cyclophosphamide seems to eliminate it. The type of
transplantation, graft-versus-host disease, growth hormone, or steroid
treatment did not influence final height. Irradiation, male gender and
young age at BMT were found to be major factors for long-term height
loss. Nevertheless, the majority of patients (140/181) have reached
adult height within the normal range of the general population.
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