Growth hormone (GH) secretion and response to GH therapy after total body irradiation and haematopoietic stem cell transplantation during childhood
B. Bakker
Department of Paediatrics, Leiden University Medical Centre, Leiden, the Netherlands,
Search for more papers by this authorW. Oostdijk
Department of Paediatrics, Leiden University Medical Centre, Leiden, the Netherlands,
Search for more papers by this authorR. B. Geskus
Department of Medical Statistics, Leiden University Medical Centre, Leiden, the Netherlands,
Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Academic Medical Center, Amsterdam, the Netherlands
Search for more papers by this authorW. H. Stokvis-Brantsma
Department of Paediatrics, Leiden University Medical Centre, Leiden, the Netherlands,
Search for more papers by this authorJ. M. Vossen
Department of Paediatrics, Leiden University Medical Centre, Leiden, the Netherlands,
Search for more papers by this authorJ. M. Wit
Department of Paediatrics, Leiden University Medical Centre, Leiden, the Netherlands,
Search for more papers by this authorB. Bakker
Department of Paediatrics, Leiden University Medical Centre, Leiden, the Netherlands,
Search for more papers by this authorW. Oostdijk
Department of Paediatrics, Leiden University Medical Centre, Leiden, the Netherlands,
Search for more papers by this authorR. B. Geskus
Department of Medical Statistics, Leiden University Medical Centre, Leiden, the Netherlands,
Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Academic Medical Center, Amsterdam, the Netherlands
Search for more papers by this authorW. H. Stokvis-Brantsma
Department of Paediatrics, Leiden University Medical Centre, Leiden, the Netherlands,
Search for more papers by this authorJ. M. Vossen
Department of Paediatrics, Leiden University Medical Centre, Leiden, the Netherlands,
Search for more papers by this authorJ. M. Wit
Department of Paediatrics, Leiden University Medical Centre, Leiden, the Netherlands,
Search for more papers by this authorSummary
Objective In January 1997 we introduced a protocol for the treatment with GH of children with impaired growth after unfractionated total body irradiation (TBI). This study is an evaluation of that protocol.
Patients and methods Between January 1997 and July 2005, 66 patients (48 male) treated for haematological malignancies had at least two years of disease-free survival after TBI-based conditioning for stem cell transplantation (SCT). Stimulated and/or spontaneous GH secretion was decreased in 8 of the 29 patients tested because of impaired growth. Treatment with GH (daily dose 1·3 mg/m2 body surface area) was offered to all 29 patients and initiated in 23 of them (17 male). The main outcome measure was the effect of GH therapy on height standard deviation scores (SDS) after onset of GH therapy, estimated by random-effect modelling with corrections for sex, age at time of SCT and puberty (data analysed on intention-to-treat basis).
Results At time of analysis, median duration of therapy was 3·2 years; median follow-up after start of GH therapy was 4·2 years. The estimated effect of GH therapy, modelled as nonlinear (logit) curve, was +1·1 SD after 5 years. Response to GH therapy did not correlate to GH secretion status.
Conclusion GH therapy has a positive effect on height SDS after TBI, irrespective of GH secretion status.
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