ESPE2021 Free Communications Growth Hormone and IGFs (6 abstracts)
Impact of pre-transplant serum-IGF-1 on hematopoietic stem cell transplantation outcome in pediatric cancer patients
Deborah Betzmann 1 , Michaela Döring 1 , Gunnar Blumenstock 2 , Friederike Erdmann 3 , Desiree Grabow 3 , Peter Lang 1 & Gerhard Binder 1
1University-Children’s Hospital, Tübingen, Germany.;2Department of Clinical Epidemiology and Applied Biometry, University of Tübingen, Tübingen, Germany.;3German Childhood Cancer Registry, Mainz, Germany
Background: Hematopoietic stem cell transplantation (HSCT) is associated with severe medical complications and variable outcome depending on the recipient’s disease stage and health condition. As serum-IGF 1 is decreased in patients with severe illness, after major surgery, in malnutrition, and other conditions that cause catabolic metabolism, it may serve as predictive biomarker for transplant outcome.
Individuals and Methods: Based on patient records, laboratory files, and follow-up data from the German Childhood Cancer Registry, we evaluated the impact of pre-transplant serum-IGF 1 on both survival and adverse events in 587 pediatric cancer patients, who underwent autologous or allogeneic HSCT (in an age < 19 years) in 1987-2014 at the University Children’s Hospital Tübingen, Germany. Serum IGF 1 was measured by an in-house RIA (mean interassay CV 8.9%), which remained the same over the entire observation period.
Results: Mean pre-transplant IGF 1 (n = 498) was low: -1.67 SDS (SD, 1.54). Completeness of follow-up three and ten years post HSCT was 96 % and 83 % respectively. The ten-year overall survival was 44.8 % (95 % confidence interval [CI], 40.6-48.9). From IGF-1 SDS Quartiles 1 to 4, there was a significant decline of transplant-related mortality (p = 0.0265), veno-occlusive disease (12; 12; 1; 3 %; P < 0.001) and thrombotic microangiopathy (5; 2; 0; 0 %; p = 0.004). IGF 1 decile 1 showed a significantly poorer outcome (P = 0.042) with lower median (12 versus 68 months) and ten-year overall survival (37 % versus 52 %) when compared to decile 2-10.
Conclusions: This study indicates pre-transplant serum-IGF 1 as a predictor of survival and selected vascular adverse events after HSCT that may have diagnostic and therapeutic relevance in pediatric cancer care.
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