Division of Pediatric Endocrinology, Department of Pediatrics, Oregon Health and Science University, Portland, Oregon 97239, USA.
Pediatr Blood Cancer. 2012 Nov;59(5):840-5. doi: 10.1002/pbc.24121. Epub 2012 Feb 29.
Imatinib mesylate, a tyrosine kinase inhibitor, is used in the treatment of chronic myelogeneous leukemia (CML). Given its ease of administration and manageable side effects in adults, imatinib mesylate was introduced as therapy for pediatric CML. Recently published case reports describe growth deceleration in children treated with imatinib. This study details the growth phenotype of seven pediatric patients maintained in remission on imatnib mesylate over an extended period of time.
This study is a retrospective chart review of pediatric patients with CML at Oregon Health & Science University treated with imatinib. Height, weight, and body mass index (BMI) measurements were collected before and during treatment. Median standard deviation scores (SDS) were analyzed by Wilcoxon Rank-Sum test and Wilcoxon signed rank cohort analysis.
Individual patient analysis demonstrated five of seven subjects with a statistically significant decrease in height SDS pre versus during treatment. The whole group analysis showed a trend to significance for difference in median height SDS pre and during treatment (P = 0.078). Bone age was delayed in all four patients in whom bone ages were obtained. IGF-1, IGFBP-3, and thyroid levels during treatment were normal. Four patients experienced an improvement in height SDS during puberty. However, three patients approaching near final adult height failed to achieve genetic height potential determined by mid-parental target height.
Growth in children with CML appears to be adversely impacted by imatinib therapy. BMI and IGF-1/IGFBP-3 are maintained during treatment, suggesting a direct effect of imatinib on the growth plate.
甲磺酸伊马替尼是一种酪氨酸激酶抑制剂，用于治疗慢性髓性白血病（CML）。由于其在成人中的使用方便且副作用可控，甲磺酸伊马替尼被引入儿科 CML 的治疗中。最近发表的病例报告描述了接受伊马替尼治疗的儿童生长减速。本研究详细描述了在延长时间内用伊马替尼维持缓解的 7 名儿科患者的生长表型。
这是俄勒冈健康与科学大学接受伊马替尼治疗的 CML 儿科患者的回顾性图表研究。在治疗前和治疗期间收集身高、体重和体重指数（BMI）测量值。采用 Wilcoxon 秩和检验和 Wilcoxon 符号秩检验对中位数标准偏差评分（SDS）进行分析。
个体患者分析表明，7 名患者中有 5 名患者的身高 SDS 在治疗前与治疗期间相比有统计学意义的下降。全组分析显示，治疗前和治疗期间中位数身高 SDS 差异有统计学意义的趋势（P=0.078）。在所有获得骨龄的 4 名患者中，骨龄均延迟。治疗期间 IGF-1、IGFBP-3 和甲状腺水平正常。4 名患者在青春期期间身高 SDS 有所改善。然而，3 名接近最终成年身高的患者未能达到由中亲身高目标决定的遗传身高潜力。
儿童 CML 的生长似乎受到伊马替尼治疗的不利影响。治疗期间 BMI 和 IGF-1/IGFBP-3 保持不变，表明伊马替尼对生长板有直接影响。
