Disturbances of growth and endocrine function after busulphan-based conditioning for haematopoietic stem cell transplantation during infancy and childhood.
It is generally assumed that busulphan/cyclophoshamide (Bu/Cy)-based conditioning regimens for haematopoietic stem cell transplantation (SCT) do not affect growth. We evaluated growth and endocrine function after Bu/Cy-based conditioning in 64 children without a history of irradiation. Mean height standard deviation scores remained stable, but unexplained disturbances of growth after SCT were found in 17/48 (35%) of the children without growth-limiting disorders (10/23 in patients treated for haematological malignancies). In 10 patients, growth hormone (GH) secretion status was evaluated, and insufficient GH secretion was diagnosed in four patients. Thyroid function was evaluable in 52 patients. Two developed antibody-mediated thyroid disorders and 10 (19%) compensated primary hypothyroidism. Gonadal function was evaluable in 21 patients and was normal in all seven patients treated with low-dose Bu (8 mg/kg), whereas seven of the 14 children receiving high-dose Bu (16-20 mg/kg) developed gonadal failure; the majority of these patients had not been exposed to gonadotoxic therapy prior to Bu/Cy. Of the 49 evaluable patients, 16 developed subclinical hyperparathyroidism. We conclude that, besides gonadal and thyroid dysfunction, impaired growth and hyperparathyroidism often occur after Bu/Cy conditioning for SCT and that growth impairment may be the result of insufficient GH secretion.
Bakker
B
B
Department of Pediatrics, J6-208, Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, The Netherlands. b.bakker@lumc.nl
Oostdijk
W
W
Bresters
D
D
Walenkamp
M J E
MJ
Vossen
J M
JM
Wit
J M
JM
D000293:Adolescent; D018906:Antineoplastic Agents, Alkylating / Q000627:therapeutic use; D001827:Body Height; D002066:Busulfan / Q000627:therapeutic use*; D002118:Calcium / Q000378:metabolism; D002648:Child; D002675:Child, Preschool; D005260:Female; D006130:Growth Disorders / Q000209:etiology; D013006:Growth Hormone / Q000378:metabolism; D019337:Hematologic Neoplasms / Q000628:therapy*; D018380:Hematopoietic Stem Cell Transplantation / Q000379:methods*; D006801:Humans; D007037:Hypothyroidism; D007153:Immunologic Deficiency Syndromes / Q000628:therapy*; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008297:Male; D008661:Metabolism, Inborn Errors / Q000628:therapy*; D033581:Stem Cell Transplantation; D013961:Thyroid Gland / Q000378:metabolism / Q000473:pathology; D013997:Time Factors; D019172:Transplantation Conditioning
D018906:Antineoplastic Agents, Alkylating; D007166:Immunosuppressive Agents; D013006:Growth Hormone; D002066:Busulfan; D002118:Calcium