Huma Z, Boulad F, Black P, Heller G, Sklar C
Department of Pediatrics, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA.
Blood. 1995 Jul 15;86(2):819-24.
We evaluated the growth of children with acute leukemia who received a bone marrow transplant (BMT) after preparation with hyperfractionated total body irradiation (TBI). Seventy-two patients (27 female and 45 male patients) with acute lymphoblastic leukemia (ALL; n = 39) or acute myelogenous leukemia (AML; n = 33) who were less than 14 years of age at BMT were studied. Before BMT all had received multiagent chemotherapy and 31 had received cranial irradiation (RT). Preparation for BMT included total body irradiation (1,375 cGy [n = 37] or 1,500 cGy [n = 35]). Heights, expressed as standard deviation scores (SDS), were studied up to 4 years post-BMT. The estimated height SDS for the entire group at the time of BMT was -0.28 +/- 0.05 and decreased to -1.11 +/- 0.22 at 4 years post-BMT (P < .0001). Using a growth curve model to compare covariate groups over the period of study, we found that the loss in height SDS was most significant in those patients who received cranial RT before BMT (P = .005). The estimated height SDS for patients treated with cranial RT went from -0.52 +/- 0.20 at transplantation to -1.83 +/- 0.23 4 years later. In contrast, patients who did not receive cranial RT before BMT showed a smaller decrease in height SDS over the 4-year observation period, ie, -0.11 +/- 0.20 decreasing to -0.73 +/- 0.21. Similarly, patients with a diagnosis of ALL had a greater loss of height SDS than those with AML (P = .033). Fifteen of 18 patients tested were found to be growth hormone (GH) deficient; 9 patients were treated with GH and all showed an improvement in growth velocity (P < .0001). We conclude that (1) children with acute leukemia who have received cranial RT and subsequently undergo BMT, primarily those with ALL, are at high risk for growth failure and GH deficiency, and (2) that fractionation of TBI may have a relative sparing effect on growth.
我们评估了接受超分割全身照射（TBI）预处理后进行骨髓移植（BMT）的急性白血病患儿的生长情况。研究对象为72例急性淋巴细胞白血病（ALL；n = 39）或急性髓细胞白血病（AML；n = 33）患儿，他们在接受BMT时年龄小于14岁（27例女性，45例男性）。在BMT前，所有患儿均接受了多药化疗，31例接受了颅脑照射（RT）。BMT的预处理包括全身照射（1375 cGy [n = 37]或1500 cGy [n = 35]）。以标准差评分（SDS）表示的身高在BMT后长达4年的时间里进行了研究。整个研究组在BMT时的估计身高SDS为-0.28±0.05，在BMT后4年降至-1.11±0.22（P <.0001）。使用生长曲线模型比较研究期间的协变量组，我们发现，在BMT前接受颅脑RT的患者中，身高SDS的降低最为显著（P =.005）。接受颅脑RT治疗的患者的估计身高SDS从移植时的-0.52±0.20降至4年后的-1.83±0.23。相比之下，在BMT前未接受颅脑RT的患者在4年观察期内身高SDS的降低较小，即从-0.11±0.20降至-0.73±0.21。同样，诊断为ALL的患者身高SDS的损失比AML患者更大（P =.033）。在18例接受检测的患者中，有15例被发现生长激素（GH）缺乏；9例患者接受了GH治疗，所有患者的生长速度均有所改善（P <.0001）。我们得出结论：（1）接受过颅脑RT并随后进行BMT的急性白血病患儿，主要是ALL患儿，生长发育失败和GH缺乏的风险很高；（2）TBI的分割照射可能对生长有相对的保护作用。
