[Analysis of some risk factors for abnormal growth velocity in children treated with haematopoetic stem cell transplantation].

Med Wieku Rozwoj 2006 Jul-Sep;10(3 Pt 1):841-8

Klinika Transplantacji Szpiku, Onkologii i Hematologii Dzieciecej, ul. Bujwida 44, 50-345 Wrocław, Poland.

Background: Late effects following haematopoietic stem cell transplantation occur both in children and adults. Endocrine impairment may cause abnormal growth velocity and impaired growth in children.

Objective: To assess the influence of preparative regimen-high dose chemotherapy and/or cranial irradiation as risk factors for growth impairment.

Material And Methods: 30 children underwent haematopoetic stem cell transplantation (19 girls, 11 boys) aged 2-20 years, with autologous (N=9) or allogeneic (N=21) maneuver. 14 children received cranial irradiation prior to grafting: 18 Gy (N=10) and 24 Gy (N-4), high doses chemotherapy included Busulfan/Melphalan (N=6), Cyclophosphamide/Busulfan/ Etoposide (N=6) and total body irradiation with 12 Gy (N=2). Thyroid function was evaluated prior to and after grafting. Growth hormone secretion with standard provocative test were analyzed. Bone age was estimated. State of nutrition 12 to 5 months before and after transplantation, WLI (weight-for-length index) and BMI (body mass index) were evaluated. Abnormal growth velocity denotes decrease > or =1 SD.

Results: 1. Cyclophosphamide statistically significantly blunted growth velocity 4 (n=28; p=0.046; r=0.4). 2. Significant correlation (n=28; p=0.0184; r=0.45) was found between abnormal gonadal function and Busulfan. 3. Cranial irradiation prior to preparative regimen impaired growth more significantly than high dose chemotherapy (n=28; p=0.0044). 4. Evaluated WLI determined short stature after transplantation (n=26; p<0.001).

Conclusion: Hematopoietic stem cell transplantation causes long term endocrine complications especially impaired growth.

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May 2007
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