Role of Busulfan and Total Body Irradiation on Growth of Prepubertal Children Riiceiving Bone Marrow Transplantation and Results of Treatment With Recombinant Human Growth Hormone

Seventy-six prepubertal children receiving autologous or allogeneic bone marrow transplantation (BMT) were enrolled in a prospective study on the impact of different pretransplant preparative regimens on growth. Patients were divided into three groups: group 1, consisting of 37 children who had received total body irradiation (TBI) and cytotoxic drugs as preparative regimen; group II, including 17 children receiving prophylactic cranial irradiation before being conditioned with TB1 and cytotoxic drugs; and group 111, composed of 22 patients transplanted after a busulfan (BUI-containing myeloablative therapy. All patients have a minimum followup of 2 years, whereas 48 and 34 patients have been studied until 3 and 4 years after transplant, respectively. Height and growth rate were expressed as standard deviation score (SDS). Growth hormone (GH) secretion in response to pharmacologic stimuli was evaluated after documented growth failure. Patients with GH deficiency were treated with recombinant human GH, and response to therapy was evaluated. The main impairment of growth rate in patients belonging to group ll was observed in the first year after TB1 (growth rate SDS changing from -0.12 k 0.23 t o -1.23 f 0.25, P < .005), with only a slight loss in the following years,