Growth hormone function and treatment following bone marrow transplant for neuroblastoma.
Previously, we reported that 26 children with stage III or IV neuroblastoma (NBL) treated with BMT grew poorly post-BMT and significantly worse than a comparison group of hematologic BMT patients. Furthermore, unlike the hematologic patients, there was no apparent catch-up growth. Six of these previously reported long-term (> 2 years) NBL patients surviving BMT were evaluated with growth hormone (GH) provocative testing, frequent (every 20 min) overnight GH sampling and IGF-1 determinations. Three of 6 patients were GH deficient based on subnormal responses to provocative stimuli and subnormal pooled 12 h GH values. Only one child had completely normal GH testing and his growth was normal. Four patients were tested with recombinant GH for a period of 12-21 months. Three patients demonstrated an improvement in their growth velocity on therapy. However, the overall response to GH treatment was significantly less than the growth response in children who are GH-deficient due to causes other than BMT. In summary, GH deficiency may be a frequent complication of BMT treatment of NBL. It also appears that the BMT treatment protocol employing total body irradiation and high-dose melphalan may induce GH resistance.
Olshan
J S
JS
Division of Pediatric Endocrinology, University of Pennsylvania School of Medicine, Children's Hospital of Philadelphia 19104.
Willi
S M
SM
Gruccio
D
D
Moshang
T
T
D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D016465:Bone Marrow Purging / Q000009:adverse effects*; D016026:Bone Marrow Transplantation; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003131:Combined Modality Therapy; D016371:Cranial Irradiation / Q000009:adverse effects*; D004351:Drug Resistance; D005260:Female; D006130:Growth Disorders / Q000188:drug therapy / Q000209:etiology* / Q000503:physiopathology; D013006:Growth Hormone / Q000172:deficiency* / Q000627:therapeutic use; D006801:Humans; D007334:Insulin-Like Growth Factor I / Q000032:analysis; D008297:Male; D008558:Melphalan / Q000008:administration & dosage / Q000009:adverse effects*; D009447:Neuroblastoma / Q000188:drug therapy / Q000401:mortality / Q000601:surgery*; D011832:Radiation Injuries / Q000209:etiology / Q000503:physiopathology; D011994:Recombinant Proteins / Q000627:therapeutic use; D017741:Survivors; D014916:Whole-Body Irradiation / Q000009:adverse effects*
D011994:Recombinant Proteins; D007334:Insulin-Like Growth Factor I; D013006:Growth Hormone; D008558:Melphalan