Growth Hormone Replacement Therapy in Children with Leukemia in Remission

Abstract

We describe a patient with leukemia in remission for 7 years who developed growth hormone (GH) deficiency and was treated with recombinant human growth hormone (rhGH). We compare her growth with that of patients from the National Cooperative Growth Study (NCGS) database, 145 with leukemia in remission and 725 with idiopathic growth hormone deficiency (IGHD) on treatment with rhGH. We also review the literature on the risk of relapse of leukemia in similar patients. The patients with leukemia in remission from the NCGS database had a significantly lower change of mean height standard deviation score than that of IGHD patients in the first, second, and third year of rhGH treatment. The relapse rate of leukemia in patients treated with rhGH is between 0.8% and 2%. Starting rhGH therapy in patients with leukemia in remission and with GH deficiency at an adequate dosage and without undue delay would improve their growth response. Such therapy does not appear to increase the risk of leukemia.

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References

1. Miller RW , Young JL Jr , Novakovic B . Childhood cancer. Cancer. 1994;75:395-405.

2. Miller RW . Persons with exceptionally high risk of leukemia. Cancer Res. 1967;27:2420-2423.

3. Tucker MA , Meadows AT , Boile JD , et al. Secondary leukemia after alkylating agents for childhood cancer. Proc Am Soc Clin Oncol. 1984;3: 85-85(abstract 6333).

4. Pizzo PA , Poplock DB , eds. Principles and Practice of Pediatric Oncology. Philadelphia: Lippincott; 1989:323-382.

5. Clayton PE , Shalet SM . Dose-dependency of onset of radiation-induced growth hormone deficiency. J Pediatr: 1991;118:226-228.

6. Graves DA . Utility of the National Cooperative Growth Study database for safety reporting. J Pediatr 1996;128 (5pt2):S1-S3.

7. Shalet SM , Beardwell CG , Morris Jones PH , et al. Growth hormone deficiency after treatment of acute leukemia in children. Arch Dis Child. 1976;51:489-493.

8. Romshe CA , Zipf WB , Miser A , et al. Evaluation of growth hormone release and human growth hormone treatment in children with cranial irradiation-associated short stature. JPe diatr 1984;104:177-181.

9. Moell C , Garwicz S , Marky I , et al. Growth in children treated for acute lymphoblastic leukemia with or without prophylactic cranial irradiation. Acta Pediatr Scand. 1988;77:688-692.

10.

10. Arguielles B , Barrios V Pozo J , et al. Modifications of growth velocity and the insulin-like growth factor system in children with acute lymphoblastic leukemia: a longitudinal study. J Clin Endocrinol Metab. 2000;85:4087-4092.

11.

11. Costin G. Effects of low-dose cranial radiation on growth hormone secretory dynamics and hypothalamic-pituitary function. AJDC. 1988;142:847-852.

12.

12. Brennan BM , Rahim A , Mackie EM , et al. Growth hormone status in adults treated for acute lymphoblastic leukemia in childhood. Clin Endocrinol (oxj). 1998;48:777-783.

13.

13. Didi M , Brennan BMD , Shalet SM . Growth hormone replacement in children treated for leukemia. J Endocrinol. 1997;152(S):P122-P122.

14.

14. Ogilvy-Stuart AL , Clayton PE , Shalet SM . Cranial irradiation and early puberty. J Clin Endocrinol Metab. 1994;78:1282-1286.

15.

15. Sulmont V , Brauner R , Fontoura M , et al. Response to growth hormone treatment and final height after cranial or craniospinal irradiation. Acta Paediatr Scand. 1990;79:542-549.

16.

16. Adan L , Souberbielle JC , Blanche S , et al. Adult height after cranial irradiation with 24 Gy: factors and markers of height loss. Acta Paediatr. 1996;85:1096-1101.

17.

17. Adan L , Souberbielle JC , Zucker JM , et al. Adult height in 24 patients treated for growth hormone deficiency and early puberty. J Clin Endocrinol Metab. 1997;82:229-233.

18.

18. Sinclair J , McClain D , Taetle R . Effect of insulin and insulin-like growth factor-I on growth of human leukemia cells in serum-free and protein-free medium. Blood. 1988;72:66-72.

19.

19. Estrov Z , Meir R , Barak Y , et al. Human growth hormone and insulin-like growth factor-I enhance the proliferation of human leukemic blasts. J Clin Oncol. 1991;9:394-399.

20.

20. Ogilvy-Stewart AL , Ryder WDJ , et al. Growth hormone and tumor recurrence. BMJ. 1992;304:1601-1605.

21.

21. Baker DL , Kees UR , Price PJ , et al. Late leukemic relapse 10 years from diagnosis in a child on recombinant human growth hormone. Pediatr Hematol Oncol. 1993;10:55-62.

22.

22. Blethen SL , Allen DB , Graves D , et al. Safety of recombinant deoxyriboncleic acid-derived growth hormone: the National Cooperative Growth Study experience. J Clin Endocrinol Metab. 1996;81:1704-1710.

23.

23. Wilton P . Is a child more likely to experience recurrence of a tumor if treated with growth hormone? In: Pharmacia & Upjohn international growth database Biannual Report 2000. KIGS Report no. 17; 2000:29-33.