Abstract
Background:
Growth impairment is a common complication after hematopoietic stem cell transplantation (SCT). The aim of this study was to evaluate the final adult height of patients who underwent SCT in childhood and to identify the factors that influence long-term growth in these patients.
Methods:
A retrospective review of 15 children who underwent SCT before puberty at Chonnam National University Hospital and reached final adult height was undertaken. To assess the severity of height reduction and to monitor the height changes longitudinally, height measurements of each patient both at the time of SCT and the final height were expressed as the height standard deviation score (SDS).
Results:
Seven children were males and eight were females with a median age of 12.8±2.4 years (range, 6.3∼14.7) at SCT. The median follow-up period was 7.1±2.0 years (range, 4.5∼11.1) and their final height was achieved at 18.1±1.5 years (range, 17.0∼21.8). Final height SDS values were within normal for the healthy population in all except two who had short stature (below ?2.0 SDS). No patient achieved height values greater than +2.0 SDS. The final height SDS value (?0.5±1.2) was not decreased from the height SDS value at SCT (?0.8±0.8). The younger age group at SCT (6.1∼10.0 years, n=5) showed significantly lower final height SDS and greater ΔSDS than the older age group (10.1∼15.0 years, n=10) (?1.5±0.6 vs. ?0.1±1.1, P<.05; ?1.2±0.7 vs. 0.5±0.8, P<.05, respectively). The irradiation-based conditioning (n=6) had negative effects on the ΔSDS (P>.05) and the final height SDS (P<.05). The gender, type of disease, donor type or the presence of chronic graft-versus-host disease did not influence height.
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Fig. 2
Final SDS (SDS at final height) and ΔSDS (final height SDS-SDS at transplantation) in different age groups. Younger age group (<10 years) shows lower final and ΔSDS than older group (>10 years).
![kjh-42-382f2.tif](/upload/SynapseXML/0072kjh/thumb/kjh-42-382f2.gif)
Fig. 3
ΔSDS (final height SDS-SDS at transplantation) in different irradiation groups. (A) Irradiation group shows lower ΔSDS than non-irradiation group. (B) ΔSDS is the lowest in patients who received TBI, followed by TLI group and no irradiation group.
![kjh-42-382f3.tif](/upload/SynapseXML/0072kjh/thumb/kjh-42-382f3.gif)
Table 1.
Clinical profiles of children at stem cell transplantation
Table 2.
Stem cell transplantation and height SDS
∗Patients with short stature. Abbreviations: AML, acute myelogenous leukemia; ALL, acute lymphoblastic leukemia; Allo, allogeneic; Ara-C, cytosine arabinoside; Auto, autologous; Bu, busulfan; Cy, cyclophosphamide; mVAMP, modified teniposide, adriamycin, melphalan, carboplatin; NB, neuroblastoma; SAA, severe aplastic anemia; SCT, stem cell transplantation; TBI, total body irradiation; TLI, total lymphoid irradiation; VP-16, etoposide.
Table 3.
Final SDS and ΔSDS by clinical parameters