Growth hormone (GH) secretion and response to GH therapy after total body irradiation and haematopoietic stem cell transplantation during childhood

• Published in: Clinical endocrinology (Oxford) Vol. 67; no. 4; pp. 589 - 597
• Main Authors: Bakker, B., Oostdijk, W., Geskus, R. B., Stokvis-Brantsma, W. H., Vossen, J. M., Wit, J. M.
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Publishing Ltd 01.10.2007; Blackwell
• Subjects: Adolescent; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Body Height - drug effects; Bone marrow, stem cells transplantation. Graft versus host reaction; Carcinoma, Papillary - diagnosis; Child; Endocrinopathies; Female; Follow-Up Studies; Fundamental and applied biological sciences. Psychology; Growth Disorders - blood; Growth Disorders - drug therapy; Growth Disorders - etiology; Growth Hormone - blood; Growth Hormone - deficiency; Hematologic Neoplasms - therapy; Hematopoietic Stem Cell Transplantation; Hormone Replacement Therapy - adverse effects; Human Growth Hormone - therapeutic use; Humans; Male; Medical sciences; Osteosarcoma - diagnosis; Thyroid Neoplasms - diagnosis; Transfusions. Complications. Transfusion reactions. Cell and gene therapy; Transplantation Conditioning; Vertebrates: endocrinology; Whole-Body Irradiation; Human; Therapy; Total body irradiation; Treatment; Adenohypophyseal hormone; Secretion; Stem cell; Somatotropin hormone; Hematopoietic cell; Stem cell transplantation; Child; Endocrinology
• ISSN: 0300-0664; 1365-2265
• DOI: 10.1111/j.1365-2265.2007.02930.x

Summary Objective  In January 1997 we introduced a protocol for the treatment with GH of children with impaired growth after unfractionated total body irradiation (TBI). This study is an evaluation of that protocol. Patients and methods  Between January 1997 and July 2005, 66 patients (48 male) treated for haematological malignancies had at least two years of disease‐free survival after TBI‐based conditioning for stem cell transplantation (SCT). Stimulated and/or spontaneous GH secretion was decreased in 8 of the 29 patients tested because of impaired growth. Treatment with GH (daily dose 1·3 mg/m2 body surface area) was offered to all 29 patients and initiated in 23 of them (17 male). The main outcome measure was the effect of GH therapy on height standard deviation scores (SDS) after onset of GH therapy, estimated by random‐effect modelling with corrections for sex, age at time of SCT and puberty (data analysed on intention‐to‐treat basis). Results  At time of analysis, median duration of therapy was 3·2 years; median follow‐up after start of GH therapy was 4·2 years. The estimated effect of GH therapy, modelled as nonlinear (logit) curve, was +1·1 SD after 5 years. Response to GH therapy did not correlate to GH secretion status. Conclusion  GH therapy has a positive effect on height SDS after TBI, irrespective of GH secretion status.