Pubertal development and growth after total-body irradiation and bone marrow transplantation for haematological malignancies

• Published in: European journal of pediatrics Vol. 159; no. 1-2; pp. 31 - 37
• Main Authors: BAKKER, B, MASSA, G. G, OOSTDIJK, W, VAN WEEL-SIPMAN, M. H, VOSSEN, J. M, WIT, J. M
• Format: Journal Article
• Language: English
• Published: Heidelberg Springer 01-01-2000; Berlin Springer Nature B.V
• Subjects: Adolescent; Age; Biological and medical sciences; Bone marrow; Bone Marrow Transplantation; Chemotherapy; Child; Child, Preschool; Children & youth; Combined Modality Therapy; Female; Fertility; Girls; Growth; Hair; Hematologic Neoplasms - radiotherapy; Hematologic Neoplasms - surgery; Hematologic Neoplasms - therapy; Hematology; Hemopathies; Humans; Infant; Leukemia; Lymphoma; Male; Medical records; Medical sciences; Ovary - physiology; Ovary - radiation effects; Patients; Pediatrics; Penis; Postoperative Period; Puberty; Puberty - radiation effects; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects); Retrospective Studies; Stem cell transplantation; Testis - physiology; Testis - radiation effects; Testosterone; Whole-Body Irradiation; Human; Iatrogenic; Homograft; Malignant hemopathy; Radiotherapy; Growth retardation; Treatment; Adolescent; Pubertal disorders; Bone marrow; Graft; Complication; Whole body; Child
• ISSN: 0340-6199; 1432-1076
• DOI: 10.1007/s004310050006

Pubertal development after total-body irradiation (TBI) was investigated in 40 children (21 boys) treated with allogeneic bone marrow transplantation (BMT) for haematological malignancies at a mean age of 11.3 years. The mean age at the last visit was 19.0 years. Twenty-five patients (15 boys) were prepubertal at BMT. Data on secondary sexual characteristics, the pituitary-gonadal axis and longitudinal growth were retrospectively collected from the medical records. In boys not receiving additional testicular irradiation (n = 19), penile growth and pubic hair development was normal and all had serum testosterone levels within the adult range. The majority of them, however, had incidental elevations of LH, suggesting minor Leydig cell damage. Testicular volume at last measurement was small (mean: 10.5 ml) and serum FSH levels were elevated in all boys, with normalisation in only one, suggesting severe impairment of reproductive gonadal function. Of the ten girls who received BMT before puberty, six had a spontaneous onset of puberty and menarche; the four other girls needed hormonal substitution therapy. Recovery of gonadal function after cessation of substitution was seen in one girl, who became pregnant but had a spontaneous abortion. Decrease in height SDS was seen in the majority of patients and was positively correlated with male gender and lower age at the time of BMT.
Careful monitoring of both gonadal function and growth after bone marrow transplantation and total body irradiation is warranted in order to detect disturbances early and ensure normal pubertal development in children treated for haematological malignancies.