Growth hormone and leukemia

Myelodysplastic syndrome during recombinant human growth hormone supplementation after treatment for neuroblastoma

At 6 months of age, the patient was diagnosed as having neuroblastoma stage IV and was given the chemotherapy, local irradiation, and operation. The treatment was completed in September 1989. In 1992, at 6 years of age, her height was -3 SD and growth hormone secretion was depressed. She had been supplemented with recombinant human growth hormone (rhGH). Because the white blood cell counts began to decrease gradually in 1993, the rhGH therapy was interrupted on January 19, 1994. The rhGH supplement was resumed after a 3-month interval because of the parent's desire. Pancytopenia soon became apparent. She was diagnosed as having myelodysplastic syndrome (MDS) as a refractory anemia with an excess of blasts in transformation with monosomy 7. The rhGH therapy was interrupted again, without any improvement of the MDS. In culture studies, neither rhGH nor insulin-like growth factor-1 stimulated proliferation of her bone marrow cells. These data suggested that the treatment with rhGH after the chemotherapy played some role in the promotion, but not acceleration, of the MDS.

Final height of patients who underwent bone marrow transplantation during childhood

OBJECTIVE

To determine the impact on final adult height of bone marrow transplantation.

METHODS

The final height of 28 long term survivors (18 males; 10 females), allografted before or at the onset of puberty, at a median age of 10.8 years (range 6.3 to 14.6) and who did not receive growth hormone (GH) treatment or other growth promoting agents, was evaluated. Median follow up period after bone marrow transplantation was 7.9 years (range 3.2 to 11.4), and age at the most recent evaluation 18.1 years (range 15.6 to 24.5). Height values were expressed in standard deviation score (SDS) from the mean of the normal population. Height at bone marrow transplantation was compared with final height as well as with parental genetic height. Patients were divided into three groups: severe aplastic anaemia (SAA): three patients given no radiotherapy; leukaemia-total body irradiation (TBI): 14 patients with acute or chronic leukaemia conditioned with chemotherapy and TBI; leukaemia-TBI with previous cranial radiation therapy (CRT): 11 patients. None of the patients had solid tumour.

RESULTS

There was a decrease in final height SDS compared to pre-transplantation height SDS (paired t test, p < 0.0001). All patients except one reached an adult height above -2.0 SDS. A significant decrease in height SDS was found in the TBI and the CRT groups (paired t test, p = 0.02 and p = 0.0002, respectively). Whereas height SDS value at the time of transplant was higher than the genetic height SDS, final height SDS values were lower.

CONCLUSIONS

Despite the decrease in height SDS found after bone marrow transplantation, 27 of the 28 patients spontaneously achieved what is considered to be a normal height SDS (above -2.0 SDS). This should be taken into account when considering GH treatment in children who underwent bone marrow transplantation for malignant haematological diseases.