GROWTH IN CHILDREN AFTER BONE-MARROW TRANSPLANTATION FOR ACUTE-LEUKEMIA
GROWTH IN CHILDREN AFTER BONE-MARROW TRANSPLANTATION FOR ACUTE-LEUKEMIA
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DOI：
10.1182/blood.v86.2.819.bloodjournal862819
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发表时间：
1995-07-15
期刊：
影响因子：
20.3
通讯作者：
SKLAR, C
中科院分区：
文献类型：
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作者：
HUMA, Z;BOULAD, F;SKLAR, C
我们评估了急性白血病儿童在接受超分割全身照射（TBI）准备后接受骨髓移植（BMT）的生长情况。研究了72例（27例女性和45例男性）急性淋巴细胞白血病（ALL; n = 39）或急性髓细胞白血病（AML; n = 33）患者，他们在BMT时年龄小于14岁。所有患者在骨髓移植前均接受过多药化疗，31例接受过头颅放疗。BMT准备包括全身照射（1，375 cGy [n = 37]或1，500 cGy [n = 35]）。研究了BMT后4年的身高，以标准差评分（SDS）表示。BMT时整个组的估计身高SDS为-0.28 +/- 0.05，BMT后4年降至-1.11 +/- 0.22（P < .0001）。使用生长曲线模型比较研究期间的协变量组，我们发现在BMT前接受颅骨PT的患者中身高SDS的损失最显著（P = 0.005）。接受颅骨RT治疗的患者的估计身高SDS从移植时的-0.52 +/- 0.20变为4年后的-1.83 +/- 0.23。相比之下，BMT前未接受颅骨RT的患者在4年观察期内身高SDS下降幅度较小，即从-0.11 +/- 0.20降至-0.73 +/- 0.21。同样，诊断为ALL的患者的身高SDS损失大于AML患者（P = 0.033）。18例受试者中有15例发现生长激素（GH）缺乏;生长激素治疗9例，生长速度均有所改善（P <0.0001），我们得出结论：（1）接受头颅RT和随后接受BMT的急性白血病儿童，主要是ALL儿童，生长障碍和GH缺乏的风险高，（2）TBI的分级可能对生长有相对的抑制作用。(C)1995年，美国血液学会。
We evaluated the growth of children with acute leukemia who received a bone marrow transplant (BMT) after preparation with hyperfractionated total body irradiation (TBI). Seventy-two patients (27 female and 45 male patients) with acute lymphoblastic leukemia (ALL; n = 39) or acute myelogenous leukemia (AML; n = 33) who were less than 14 years of age at BMT were studied. Before BMT all had received multiagent chemotherapy and 31 had received cranial irradiation (RT). Preparation for BMT included total body irradiation (1,375 cGy [n = 37] or 1,500 cGy [n = 35]). Heights, expressed as standard deviation scores (SDS), were studied up to 4 years post-BMT, The estimated height SDS for the entire group at the time of BMT was -0.28 +/- 0.05 and decreased to -1.11 +/- 0.22 at 4 years post-BMT (P < .0001). Using a growth curve model to compare covariate groups over the period of study, we found that the loss in height SDS was most significant in those patients who received cranial PT before BMT (P = .005). The estimated height SDS for patients treated with cranial RT went from -0.52 +/- 0.20 at transplantation to -1.83 +/- 0.23 4 years later. In contrast, patients who did not receive cranial RT before BMT showed a smaller decrease in height SDS over the 4-year observation period, ie, -0.11 +/- 0.20 decreasing to -0.73 +/- 0.21. Similarly, patients with a diagnosis of ALL had a greater loss of height SDS than those with AML (P = .033). Fifteen of 18 patients tested were found to be growth hormone (GH) deficient; 9 patients were treated with GH and all showed an improvement in growth velocity (P < .0001), We conclude that (1) children with acute leukemia who have received cranial RT and subsequently undergo BMT, primarily those with ALL, are at high risk for growth failure and GH deficiency, and (2) that fractionation of TBI may have a relative sparing effect on growth.(C) 1995 by The American Society of Hematology.