Acceleration of retarded growth in children with Gaucher disease after treatment with alglucerase

OBJECTIVES

The incidence and severity of growth retardation in children with type 1 Gaucher disease and the response to enzyme replacement therapy with alglucerase were studied.

STUDY DESIGN

A retrospective analysis of growth in 99 children and adolescents with type 1 Gaucher disease before treatment, and in 54 of those subjects during treatment, was done. Growth was compared with gender, age, and dosage of replacement enzyme.

RESULTS

Linear growth was normal in the first 1 to 2 years of life and then decelerated. Height was at or below the 5th percentile in 50% of all subjects immediately before treatment. The mean z score was -1.49 (95% confidence interval, -1.83 to -1.16), corresponding to the 6.8th percentile for height. Seventy-two percent were below the 50th percentile and 50% were at or below the 5th percentile for mid-parental height (p <0.001). One and one-half years after treatment was started, the estimated mean z score for all subjects was -1.01, which corresponds to the 16th percentile for height. Normal growth was achieved within 4 to 30 months in eight of nine subjects who were at or below the 5th percentile. It occurred only in those receiving higher doses (60 to 120 U/kg per 4-week period) of alglucerase. There was a significant association between z scores for height before treatment and liver enlargement (r= 0.57; p < 0.01).

CONCLUSIONS

Half of the subjects who manifest type 1 Gaucher disease in childhood have growth retardation. Treatment with adequate amounts of modified enzyme replacement was effective in normalizing linear growth.

MR imaging of patients with type 1 Gaucher's disease: relationship between bone and visceral changes

OBJECTIVE

Because treatment is now available for patients with Gaucher's disease, methods of follow-up have become important in making treatment decisions. Bone abnormalities (infarct and avascular necrosis) tend to be irreversible while visceral volumes are not, suggesting that it may be useful to follow patients with visceral volume determinations. In order to do so, the relationship of one to the other must first be understood. The purpose of this paper is to determine the relationships between bone and visceral changes identified with MR imaging.

MATERIALS AND METHODS

Sixty-two consecutive patients from 1 to 78 years old with type 1 Gaucher's disease were studied by MR imaging. The examination consisted of two parts: T1-weighted MR images and gradient-echo coronal MR images of the hips and femurs, and axial breath-holding MR images of the abdomen that allowed measurement of hepatic and splenic volume. The bone changes were classified and were correlated with the liver and spleen volumes. Specific imaging features of the liver and spleen were noted and correlation sought.

RESULTS

A statistically significant difference in liver size was found between patients with and without avascular necrosis. A statistically significant correlation was also found between liver size and avascular necrosis. Patients with marrow changes classified as grade 2 or higher were significantly more likely to have avascular necrosis. Nineteen percent of patients had splenic nodules and 7% had hepatic nodules; however, there was no correlation between the nodules and bone changes.

CONCLUSION

MR imaging showed a statistical relationship between marrow changes, liver size, and avascular necrosis in patients with type 1 Gaucher's disease. Knowledge of this relationship may be used in dosage and treatment considerations in the follow-up and clinical management of these patients.