5 GROWTH AND GROWTH HORMONE IN CHILDREN AFTER ALLOGENEIC BONE MARROW TRANSPLANTATION

Abstract

All children surviving bone marrow transplantation (BMT) 1980-84 have been followed every year regarding their growth. There are 21 long time survivors age 1-14 at the time of BMT, 3 had severe aplastic anemia (SAA), 18 had leukemia. All patients were conditioned with cyklophosphamide, leukemic children also had 10 GY of total body irradiation (TBI) delivered by a linear accelerator at a mean dose rate <0,05 GY/min.

The children who suffered from SAA have all grown normally after BMT. The remaining 18 show a poor growth during the first year after BMT, 7/18 deviated -1 SD or more. Growth hormone (GH) stimulation tests with insulin and arginine were performed every year. Though growth was poor the first year, 19/20 had a normal GH response. At year three, however, 10/18 failed to respond normally. To further investigate physiological GH secretion, 24 hour profiles were done in 13 cases. In 5 of these, there was not one significant GH-peak (>8 ug/l). 4 children had one peak and 4 children had 3-5 peaks. Also when calculating the area over baseline, 7/10 had obvious pathological profiles. So far, 6 children had injection therapy of GH for more than 6 months, 4 show increment of growth velocity.

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