Growth retardation is frequent in transplanted pediatric patients receiving total body irradiation (TBI). Approximately 45% of children receiving transplants will have markedly reduced growth rates for two years post-transplant. [1]
Chemotherapy-only regimens for pre-pubertal children are preferred for this reason. Growth hormone deficiency is common; early diagnosis and treatment with synthetic growth hormone achieves the best response.
Hypothyroidism can occur in patients receiving irradiation to the head, and therefore should be avoided in children whenever possible. In some cases this may not be possible, as with a cancer with CNS involvement (e.g., in acute lymphoblastic leukemia). Transplant recipients with hypothyroidism should receive replacement hormones.
In pediatric BMT patients, there is the potential for radiation to interfere with the development of the teeth and face. Underdevelopment of the mandible is of particular concern. Changes in dental and facial development are most severe in children under the age of seven when transplanted.
Avoiding conditioning regimens with radiation is the major preventative measure available, but increased diligence to oral hygiene can also minimize dental complications. [1]
The HCT Quick Reference Guidelines include post-transplant care recommendations for pediatric patients. Access guidelines >
Reference
- Sanders JE. Growth and Development after hematopoietic cell transplantation. In Blume KG, Forman SJ, Appelbaum FR, editors: Thomas' Hematopoietic Cell Transplantation, 3rd ed. Oxford, England: Blackwell, 2004:929-943.