Department of Hematology and Oncology, Kobe Children's Hospital, Kobe, Japan.
Department of Endocrinology and Metabolism, Kobe Children's Hospital, Kobe, Japan.
Cancer Med. 2023 Aug;12(16):17018-17027. doi: 10.1002/cam4.6336. Epub 2023 Jul 11.
The present study aimed to examine the association between the conditioning intensity and height growth in pediatric patients who underwent allogeneic hematopoietic stem cell transplantation (allo-HSCT).
We reviewed the clinical records of 89 children with malignant diseases who underwent initial allo-HSCT between 2003 and 2021. Height measurements were standardized using standard height charts prepared by the Japanese Society for Pediatric Endocrinology to calculate standard deviation score (SDS). We defined short stature as a height SDS less than -2.0 in that reference. Myeloablative conditioning (MAC) comprised total-body irradiation at more than 8 Gy and busulfan administration at more than 8 mg/kg (more than 280 mg/m ). Other conditioning regimens were defined as reduced intensity conditioning (RIC).
A total of 58 patients underwent allo-HSCT with MAC, and 31 patients received allo-HSCT with RIC. There were significant differences in the height SDS at 2 and 3 years after allo-HSCT between MAC and RIC group (-1.33 ± 1.20 vs. -0.76 ± 1.12, p = 0.047, -1.55 ± 1.28 vs. -0.75 ± 1.11, p = 0.022, respectively). Multivariate logistic regression analysis with the adjustments for potential confounding factors of patients less than 10 years of age at allo-HSCT and chronic graft-versus host disease demonstrated that MAC regimen was associated with a markedly increased risk of a short stature at 3 years after allo-HSCT (adjusted odds ratio, 5.61; 95% confidence interval, 1.07-29.4; p = 0.041).
The intensity of conditioning regimen may be associated with short statures after allo-HSCT.
本研究旨在探讨异基因造血干细胞移植（allo-HSCT）后儿科患者的预处理强度与身高增长之间的关系。
我们回顾了 2003 年至 2021 年间接受初次 allo-HSCT 的 89 例恶性疾病儿童的临床记录。采用日本儿科内分泌学会制定的标准身高图表对身高进行标准化测量，以计算标准差评分（SDS）。我们将身高 SDS 小于-2.0 定义为矮小症。骨髓清除性预处理（MAC）包括全身照射超过 8Gy 和白消安剂量超过 8mg/kg（超过 280mg/m²）。其他预处理方案定义为强度降低预处理（RIC）。
共有 58 例患者接受 MAC allo-HSCT，31 例患者接受 RIC allo-HSCT。MAC 组和 RIC 组在 allo-HSCT 后 2 年和 3 年的身高 SDS 存在显著差异（-1.33±1.20 与-0.76±1.12，p=0.047；-1.55±1.28 与-0.75±1.11，p=0.022）。对allo-HSCT 时年龄小于 10 岁和慢性移植物抗宿主病等潜在混杂因素进行调整的多变量逻辑回归分析显示，MAC 方案与 allo-HSCT 后 3 年发生矮小症的风险显著增加相关（调整后的优势比，5.61；95%置信区间，1.07-29.4；p=0.041）。
预处理方案的强度可能与 allo-HSCT 后矮小症有关。
