Improved renal function after five years of GH therapy in GH deficient (GHD) adult survivors of childhood leukaemia
C. Follin, T. Wiebe, C. Moëll & E. Erfurth
Introduction: Acute lymphoblastic leukaemia (ALL) is the most common childhood malignancy. The survival rate is now 85% which emphasis the importance of long-term treatment complications. GH-deficiency (GHD) is common among these survivors treated with cranial radiotherapy (CRT) and chemotherapy. Renal impairment has been reported in childhood (CO) cancer survivors and glomerular filtration rate (GFR) is decreased in hypopituitarism. GH therapy to CO GHD patients has been shown to increase GFR.
Methods: In 44 (21 women) ALL patients, treated with 24 Gy CRT and chemotherapy and 44 matched controls GFR (ml/min) was investigated. We used Cystatin C (CysC) to estimate GFR. The level of CysC in serum is less influenced by body composition than creatinine. The median age was 25 years (1931 years) and 91% of the patients were GHD. In 16 GHD ALL patients the effect of 5 years of GH therapy on GFR was evaluated and compared to 16 matched controls.
Results: At baseline the ALL patients had significantly lower GFR compared to controls (P=0.01). After 5 years of GH therapy GFR improved among the ALL patients (P=0.04). Two patients had subnormal GFR (<60 ml/min) at baseline and GFR was normalized in these patients after GH therapy. After 5 years no significant difference in GFR between patients and controls was recorded (P=0.2). When stratified for gender, GFR improved significantly among the men (P=0.01), but not among the women (P>0.3).
Conclusion: GHD adult survivors of CO ALL have impaired renal function compared to matched controls 20 years after ALL diagnosis. Five years of a low dose of GH therapy improved renal function among the ALL patients, particularly among the men. Whether higher GH doses in women will improve their renal function needs further investigation.
Declaration of interest: The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research project.
Funding: This research did not receive any specific grant from any funding agency in the public, commercial or not-for-profit sector.