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Growth in children after bone marrow transplantation: busulfan plus
cyclophosphamide versus cyclophosphamide plus total body irradiation
JR Wingard, LP Plotnick, CS Freemer, M Zahurak, S Piantadosi, DF Miller, HM Vriesendorp, AM Yeager and GW Santos
Bone Marrow Transplantation Program, Johns Hopkins Oncology Center,
Baltimore, MD.
Growth was assessed during the first and second years following bone marrow
transplantation (BMT) in 47 children treated by either busulfan plus
cyclophosphamide (BU/CY) (n = 24) or cyclophosphamide plus fractionated
total body irradiation (CY/TBI) (n = 23). Before transplant, the median
height was only 0.2 SD below age- and sex- adjusted means (range, -2.5 to
+3.0). Height was greater than 2.0 SD below normal in only three patients
(6%). The pretransplant heights were comparable in the BU/CY and CY/TBI
groups (-0.1 v -0.6 SD, P = .35). Following transplant, median 1- and
2-year heights were 0.7 and 0.9 SD below normal, respectively. Growth rates
were 2.2 SD and 1.4 SD below normal during the first and second years,
respectively. Growth rates were greater than 2.0 SD below normal in 24 of
47 (51%) at 1 year and in 12 of 31 (39%) at 2 years after transplant.
Growth rates in patients treated with BU/CY were comparable to those
treated with CY/TBI during both years: -2.5 versus -1.7 SD during the first
year (P = .19, Wilcoxon), and -1.5 versus -1.1 SD during the second year (P
= .61). Growth rates during the second year correlated with growth rates
during the first year (r = .36, P = .046). Growth rates during the first
year were lower in patients who had been given prior cranial irradiation,
those who were near pubertal age at the time of transplant, and those who
were transplanted for a disease other than acute lymphoblastic leukemia
(ALL). During the second year, poor rates of growth were associated only
with the use of corticosteroids after transplant.
Volume 79,
Issue 4,
pp. 1068-1073,
02/15/1992
Copyright © 1992 by The American Society of Hematology
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