Late leukemic relapse 10 years from diagnosis in a child on recombinant human growth hormone.
A 12 year-old girl developed a late relapse of acute lymphoblastic leukaemia (ALL) 10 years from first presentation. Initial chemotherapy included vincristine, methotrexate, prednisolone, and L-asparaginase with cranial radiotherapy (18 Gy) for central nervous system prophylaxis. Documented growth failure led to recombinant human growth hormone (rhGH) replacement therapy being instituted in May 1989, 6 years from end of therapy and 2 years prior to relapse. Three independent experiments demonstrated no increased cell proliferation in vitro when the patient's thawed cryopreserved fresh leukemic cells were incubated with rhGH. However, a pre-T ALL cell line (PER-255) consistently demonstrated enhanced proliferation when incubated with rhGH (132.1 +/- 13.4%, P < 0.01). Growth hormone has been associated with an increased incidence of leukemia and may be implicated in the late relapse of this child. The use of growth hormone in children with a past history of ALL needs to be examined critically in the light of the potential risk of inducing leukemic relapse.
Baker
D L
DL
Department of Haematology/Oncology, Princess Margaret Hospital for Children, Perth, Western Australia.
Kees
U R
UR
Price
P J
PJ
Willoghby
M L
ML
D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001853:Bone Marrow / Q000473:pathology; D002455:Cell Division / Q000187:drug effects; D002675:Child, Preschool; D005260:Female; D006130:Growth Disorders / Q000188:drug therapy*; D013006:Growth Hormone / Q000009:adverse effects* / Q000494:pharmacology / Q000627:therapeutic use; D006801:Humans; D007938:Leukemia; D008940:Mitotic Index; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000139:chemically induced* / Q000188:drug therapy* / Q000473:pathology; D011994:Recombinant Proteins / Q000009:adverse effects* / Q000494:pharmacology / Q000627:therapeutic use; D012008:Recurrence; D012074:Remission Induction; D014407:Tumor Cells, Cultured
D011994:Recombinant Proteins; D013006:Growth Hormone