Patterns of Growth and Body Proportions After Total-Body Irradiation and Hematopoietic Stem Cell Transplantation During Childhood

http://www.pedresearch.org/cgi/content/abstract/59/2/259

CLINICAL INVESTIGATIONS

Patterns of Growth and Body Proportions After Total-Body
Irradiation and Hematopoietic Stem Cell Transplantation During Childhood

BOUDEWIJN BAKKER, WILMA OOSTDIJK, RONALD B. GESKUS, W. HENRIËTTE
STOKVIS-BRANTSMA, JAAK M. VOSSEN and JAN M. WIT

Department of Pediatrics [B.B., W.O., W.H.S.-B., J.M.V., J.M.W.],
Department of Medical Statistics [R.B.G.], Leiden University Medical
Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands

Patterns of growth and body proportions were studied in 75 children
receiving total-body irradiation (TBI) and hematopoietic stem cell
transplantation (SCT) before onset of puberty. Of the 19 patients
receiving GH, only data obtained before onset of GH were included.
Thirty-two patients reached final height (FH). Median change in height
SD score (SDS) between SCT and FH was –1.7 in boys and –1.1 in girls.
Peak height velocity (PHV) was decreased in the majority of the
patients (median PHV 5.7 cm/y in boys and 5.3 cm/y in girls), even
though it occurred at appropriate ages. Changes in body proportions
were analyzed by linear mixed-effects models. Decrease in sitting
height SDS did not differ between boys and girls. In boys, decrease in
leg length SDS was of comparable magnitude, whereas, in girls, decrease
in leg length was less pronounced, leading to a significant decrease in
SDS for sitting height/height ratio in girls only. The sex-specific
effects of several variables on height SDS were analyzed by linear
mixed-effects modeling, showing a slightly faster decrease in younger
children and a more pronounced decrease during puberty in boys compared
with girls. We conclude that 1) younger children are more susceptible
to growth retardation after TBI and SCT, 2) pubertal growth is more
compromised in boys, and 3) leg growth is relatively less affected in
girls, possibly due to a high incidence of gonadal failure in girls.

Abbreviations:
FH, final height
PHV, peak height velocity
SCT, stem cell transplantation
SDS, standard deviation score
TBI, total-body irradiation

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