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Bone Mineral Density, Growth, and Thyroid Function in Long-Term Survivors of Pediatric Hodgkin’s Lymphoma Treated with Chemotherapy Only

Departments of Pediatric Oncology/Hematology (R.D.v.B., M.M.v.d.H.-E., F.G.H.-C., R.P.) and Pediatric Endocrinology (R.D.v.B., S.M.P.F.d.M.K.-S.), Erasmus Medical Center-Sophia Children’s Hospital, 3000 CB Rotterdam, The Netherlands; Departments of Pediatric Oncology (C.v.d.B.) and Medical Oncology (H.J.H.v.d.P.), Academic Medical Center-Emma Children’s Hospital, 1081 HV Amsterdam, The Netherlands; and Departments of Nuclear Medicine (E.P.K.) and Clinical Chemistry (Y.B.d.R.), Erasmus Medical Center, 3000 DR Rotterdam, The Netherlands

Address all correspondence and requests for reprints to: Sabine M. P. F. de Muinck Keizer-Schrama, Erasmus Medical Center-Sophia Children’s Hospital, Room Sp3435, P.O. Box 2060, 3000 CB Rotterdam, The Netherlands. E-mail: s.demuinckkeizer-schrama{at}erasmusmc.nl.

Background: The aim of this study was to investigate the long-term side effects of treatment for childhood Hodgkin’s lymphoma with chemotherapy only on growth, bone mineral density (BMD), body composition, and thyroid function.

Procedure: A total of 88 patients (56 male, 32 female; 17.6–42.6 yr), treated for childhood Hodgkin’s lymphoma from 1974–1998 with combination chemotherapy adriamycin (doxorubicin), bleomycin, vinblastine, and dacarbazine or epirubicin, bleomycin, vinblastine, dacarbazine with or without mechlorethamine, oncovin (vincristine), procarbazine, and prednisone (MOPP) with the intention to avoid radiotherapy, participated in this study. Median follow-up was 15.5 yr (range 5.6–30.2). BMD of lumbar spine and total body (BMD-TB), and body composition were measured using dual-energy x-ray absorptiometry. Bone mineral apparent density of the lumbar spine was calculated to correct for bone size. Free T₄ and TSH were measured.

Results: Men treated with MOPP had a significantly reduced height with normal body proportions. Women treated with MOPP had decreased BMD-TB and bone mineral apparent density of the lumbar spine as compared with healthy controls. Percent body fat was significantly increased in female patients treated without MOPP. Body mass index was significantly increased in male patients treated without MOPP, whereas lean body mass was normal in all patients. All patients, except one, treated with chemotherapy only had normal thyroid function. However, five patients who received additional radiation to the thyroid either had abnormal levels of TSH or free T₄, or used thyroid hormones.

Conclusions: Lean body mass was normal in all patients; thyroid function was normal in all but one patient. The use of MOPP leads to decreased height and increased body mass index in men and decreased BMD-TB in women.

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