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Adult height and growth hormone therapy in childhood acute lymphoblastic leukemia survivors treated with total body irradiation and hematopoietic stem cell transplantation before puberty

Bone Marrow Transplantation volume 60, pages 718–720 (2025)Cite this article

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Allogenic hematopoietic stem cell transplantation (allo-HSCT) after TBI-based conditioning regimens remains an essential treatment for high-risk and relapsed ALL [1]. TBI, in association with cytotoxic drugs, has been described to significantly alter growth through its combined damage on the hypothalamic-pituitary axis, on gonadal and thyroid functions and on epiphyseal growth plates of the spinal column [2,3,4,5]. The reported incidence of growth hormone (GH) deficiency after HSCT varies widely (20%–85%), with studies reporting heterogeneous inclusion criteria (patients with different diseases, ages or conditioning regimens) and only few studies reporting adult final height (AH) [2, 4, 6,7,8]. The use of GH therapy (GHTx) has also been reported, but its efficacy is still controversial with persistent fear of complications such as secondary malignancies or impact on metabolic syndrome occurrence [2, 4, 8, 9].

The present study aimed to evaluate impact of HSCT after a TBI-based conditioning regimen on the AH, GH deficiency, and GHTx of 176 adult patients included in the LEA program and treated for ALL before puberty (i.e. 9 years old for females and 11 for male patients). GH deficiency was diagnosed using a combination of clinical evaluation (growth patterns, height velocity, and target height) and biological markers (Insulin-Like Growth Factor 1 plasma levels and two GH stimulation tests). All patients provided written informed consent. The study was approved by the French National Program for Clinical Research and the National Cancer Institute. See supplementary for more details on methods.

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Fig. 1: Evolution of height from diagnosis to adult height.

Data availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Acknowledgements

The authors would like to thank the LEA study group (Online supplementary Data) for data collection and the patients and family members for their kind cooperation in this study. Trial registration clinicaltrials.gov identifier NCT 01756599.

Funding

The study was funded by Laurette Fugain Association (ALF), the French National Cancer Institute (INCa), the Cancéropôle PACA, and the Ligue contre le Cancer.

Author information

Authors and Affiliations

  1. Pediatric Hematology and Immunology Department, Robert-Debré Hospital, GHU APHP Nord Université Paris Cité, Paris, France

    Charlotte Calvo, André Baruchel & Jean-Hugues Dalle

  2. INSERM UMR-976, Institut de Recherche Saint-Louis (IRSL UMR-1342), Paris, France

    Charlotte Calvo & Jean-Hugues Dalle

  3. Pediatric Endocrinology Department, Robert-Debré Hospital, Paris Cité University, Paris, France

    Coline Mornet, Caroline Storey, Jean-Claude Carel & Laura Atger

  4. Pediatric Hematology and Immunology Department, Institut d’Hémato-Oncologie Pédiatrique (IHOP), Lyon, France

    Carine Halfon-Domenech

  5. Department of Pediatric Onco-Hematology, Hôpital d’Enfants de Brabois, Vandoeuvre Les Nancy, Nancy, France

    Cécile Pochon

  6. Department of Pediatric Hematology and Oncology, Armand Trousseau Hospital, Sorbonne University, AP-HP, Paris, France

    Marie-Dominique Tabone & Guy Leverger

  7. Department of Pediatric Hematology-oncology, University Hospital, Strasbourg, France

    Catherine Paillard

  8. Department of Pediatric Hematology and Oncology, University Hospital of Bordeaux, Bordeaux, France

    Marie Angoso

  9. Pediatric Hematology and Oncology Department, University Hospital L’Archet, Nice, France

    Marilyne Poirée

  10. Department of Pediatric Hematology-Oncology, University Hospital of Grenoble, Grenoble, France

    Dominique Plantaz

  11. Department of Pediatric Hematology and Oncology, CIC Inserm 501, University Hospital of Clermont-Ferrand, Clermont-Ferrand, France

    Justyna Kanold

  12. Department of Pediatric Hematology and Oncology, University Hospital of Rennes, Rennes, France

    Virginie Gandemer

  13. Department of Pediatric Hematology and Oncology, University Hospital, Montpellier, France

    Anne Sirvent

  14. Department of Pediatric Hematology-Oncology, University Hospital St Etienne, St Etienne, France

    Sandrine Thouvenin

  15. Department of Pediatric Hematology-Oncology, Toulouse University Hospital, Toulouse, France

    Marlène Pasquet

  16. Aix Marseille Univ, UR3279 CERESS, Department of Public Health APHM Marseille, Marseille, France

    Julie Berbis & Pascal Auquier

  17. Aix Marseille Univ, APHM, CERESS, La Timone Children’s Hospital, Department of pediatric hematology, immunology and oncology, Marseille, France

    Gérard Michel

  18. Aix Marseille Univ, APHM, INSERM, INRAe, C2VN, La Timone Children’s Hospital, Department of pediatric hematology, immunology and oncology, Marseille, France

    Paul Saultier

Authors
  1. Charlotte Calvo
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  2. Coline Mornet
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  3. Caroline Storey
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  4. Carine Halfon-Domenech
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  5. Cécile Pochon
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  6. Marie-Dominique Tabone
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  7. Guy Leverger
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  8. André Baruchel
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  9. Catherine Paillard
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  10. Marie Angoso
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  11. Marilyne Poirée
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  12. Dominique Plantaz
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  13. Justyna Kanold
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  14. Virginie Gandemer
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  15. Anne Sirvent
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  16. Sandrine Thouvenin
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  17. Marlène Pasquet
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  18. Jean-Claude Carel
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  19. Laura Atger
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  20. Julie Berbis
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  21. Pascal Auquier
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  22. Jean-Hugues Dalle
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  23. Gérard Michel
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  24. Paul Saultier
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Contributions

CC performed research, analyzed data and wrote the manuscript; PS and GM designed and supervised the research, and participated in writing the manuscript; CM, CS, LA and PA analyzed data; CHD, CP, MDT, GL, AB, CP, MA,MP, DP, JK, VG, AS, ST, MP, JCC, JB and JHD collected data. All authors revised the manuscript and gave final approval of the manuscript to be published.

Corresponding author

Correspondence to Charlotte Calvo.

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The authors declare no competing interests.

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Calvo, C., Mornet, C., Storey, C. et al. Adult height and growth hormone therapy in childhood acute lymphoblastic leukemia survivors treated with total body irradiation and hematopoietic stem cell transplantation before puberty. Bone Marrow Transplant 60, 718–720 (2025). https://doi.org/10.1038/s41409-025-02532-2

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  • DOI: https://doi.org/10.1038/s41409-025-02532-2

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