Final height and hormonal function after bone marrow transplantation in children.
OBJECTIVE
To analyze final height and hormonal function in long-term survivors of bone marrow transplantation (BMT).


METHODS
Group 1 consisted of 16 patients (10 boys) with a hematologic malignancy, mostly leukemia, conditioned for BMT with total body irradiation (TBI), 7.5 to 12 Gy, and cyclophosphamide. Group 2 consisted of 14 patients (9 boys) with severe aplastic anemia, conditioned with chemotherapy only.


RESULTS
In group 1, patients achieved a reduced final height after BMT. The difference between the height standard deviation score (SDS) at BMT and the height SDS at final height was -1.96 (0.82) SDS in boys and -0.92 (0.71) SDS in girls (p = 0.0001, and p = 0.02 respectively). Final height was also lower than target height (boys, p = 0.01; girls, p = 0.03). Prepubertal growth in the first 3 years after BMT was normal but pubertal height gain was decreased. The patients in group 2 achieved normal height. Thyroid function and adrenal function were normal in all patients, and no growth hormone deficiency was detected. Serum follicle-stimulating hormone values after BMT were increased in all group 1 patients, with return to normal in two patients. Serum luteinizing hormone values were increased in all group 1 girls, with recovery in one girl. Normal serum luteinizing hormone values and spontaneous puberty were found in all group 1 boys. In group 2, disturbances in gonadotropins were seen only in three boys and two girls.


CONCLUSIONS
In patients treated in childhood with BMT after chemotherapy and TBI with 7.5 Gy or more, final height is compromised because of blunted growth in puberty. Patients who had not received TBI suffered no height loss. In the majority of patients, the combination of chemotherapy and TBI also resulted in irreversible disturbances of gonadal function.
Clement-De Boers
A
A
Department of Pediatrics, University Hospital, Leiden, The Netherlands.
Oostdijk
W
W
Van Weel-Sipman
M H
MH
Van den Broeck
J
J
Wit
J M
JM
Vossen
J M
JM
D000293:Adolescent; D000741:Anemia, Aplastic / Q000628:therapy; D001827:Body Height; D016026:Bone Marrow Transplantation; D003520:Cyclophosphamide / Q000627:therapeutic use; D005260:Female; D005640:Follicle Stimulating Hormone / Q000097:blood; D019337:Hematologic Neoplasms / Q000628:therapy; D019382:Human Growth Hormone / Q000097:blood; D006801:Humans; D007986:Luteinizing Hormone / Q000097:blood; D008297:Male; D010908:Pituitary Hormones, Anterior / Q000097:blood*; D012189:Retrospective Studies; D017741:Survivors; D019172:Transplantation Conditioning / Q000379:methods*; D014916:Whole-Body Irradiation
D010908:Pituitary Hormones, Anterior; D019382:Human Growth Hormone; D003520:Cyclophosphamide; D007986:Luteinizing Hormone; D005640:Follicle Stimulating Hormone