title: Growth hormone improves short stature in children with Diamond-Blackfan anemia.
abstract: BACKGROUND
  Diamond-Blackfan anemia (DBA), an inherited marrow failure syndrome, has severe hypoplastic anemia in infancy and association with aplastic anemia, MDS/leukemia, and other malignancies. Short stature is present in most patients. Isolated cases have demonstrated improved growth on growth hormone (GH) therapy.
  
  
  METHODS
  GH treatment data were obtained from 19 children with DBA (6 at our site and 13 from Genentech). Control data from 44 non-GH treated children were provided by Diamond Blackfan Anemia Registry. Annual growth velocity (GV) and height-for-age Z-scores (HAZ) were compared between groups and for up to 4y of GH treatment.
  
  
  RESULTS
  Constructed DBA-specific male and female height-for-age charts for non-GH treated patients revealed short stature compared to CDC norms. GH-treated patients had significantly lower HAZ prior to treatment initiation compared to non-GH-treated controls. Among GH-treated patients, GV significantly improved in the first two years relative to pre-treatment. HAZ significantly improved in each of 4y of GH therapy compared to baseline. After 2y of therapy, HAZ for GH-treated patients were not significantly different from controls, demonstrating successful catch-up growth.
  
  
  CONCLUSIONS
  GH treatment in children with DBA improves both GV and HAZ during treatment sustained for up to 4y. Very short children with DBA can be treated successfully with GH to restore stature to levels comparable to less affected patients. DBA height charts are useful tools for assessing age-specific growth in this typically short population. Careful consideration of individualized benefit of GH therapy versus risk is important in view of long-term underlying ∼5% malignancy risk in DBA.
authors.affiliation: Divisions of Endocrinology, Bone Marrow Transplantation and Immune Deficiency, Department of Pediatrics, Cincinnati Children's Hospital Medical Center and University of Cincinnati, Cincinnati, Ohio.
authors.forename: Jonathan C
authors.initials: JC
authors.lastname: Howell
authors.forename: Sarita A
authors.initials: SA
authors.lastname: Joshi
authors.forename: Lindsey
authors.initials: L
authors.lastname: Hornung
authors.forename: Jane
authors.initials: J
authors.lastname: Khoury
authors.forename: Richard E
authors.initials: RE
authors.lastname: Harris
authors.forename: Susan R
authors.initials: SR
authors.lastname: Rose
mesh_terms: D000293:Adolescent; D000328:Adult; D029503:Anemia, Diamond-Blackfan / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006130:Growth Disorders / Q000209:etiology / Q000503:physiopathology; D019382:Human Growth Hormone / Q000008:administration & dosage*; D006801:Humans; D008297:Male; D012042:Registries
chemical_list: D019382:Human Growth Hormone
keywords: Diamond Blackfan anemia; bone marrow failure; glucocorticoids; growth hormone; growth velocity; height; puberty; steroids