¹Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA

Correspondence: Dr JE Sanders, Clinical Research Division, Fred Hutchinson Cancer Research Center, 1100 Fairview Avenue North, Suite D5-280, PO Box 19024, Seattle, WA 98109-1024, USA. E-mail: jsanders@fhcrc.org

Received 15 August 2007; Revised 30 August 2007; Accepted 30 August 2007; Published online 8 October 2007.

Abstract

Hematopoietic cell transplantation (HCT) following high-dose chemotherapy or chemoradiotherapy for children with malignant or nonmalignant hematologic disorders has resulted in an increasing number of long-term disease-free survivors. The preparative regimens include high doses of alkylating agents, such as CY with or without BU, and may include TBI. These agents impact the neuroendocrine system in growing children and their subsequent growth and development. Children receiving high-dose CY or BUCY have normal thyroid function, but those who receive TBI-containing regimens may develop thyroid function abnormalities. Growth is not impacted by chemotherapy-only preparative regimens, but TBI is likely to result in growth hormone deficiency and decreased growth rates that need to be treated with synthetic growth hormone therapy. Children who receive high-dose CY-only have normal development through puberty, whereas those who receive BUCY have a high incidence of delayed pubertal development. Following fractionated TBI preparative regimens, approximately half of the patients have normal pubertal development. These data demonstrate that the growth and development problems after HCT are dependent upon the preparative regimen received. All children should be followed for years after HCT for detection of growth and development abnormalities that are treatable with appropriate hormone therapy.