Evaluation of growth hormone and insulin-like growth factor-1 in children during and after therapy for acute lymphoblastic leukemia

Background Higher levels of growth hormone (GH) and insulin-like growth factor-1 (IGF-1) stimulate the growth of myeloid and lymphoid cells and may contribute to leukemogenesis. Aim The aim of this study was to evaluate serum GH and IGF-1 levels in children with acute lymphoblastic leukemia (ALL) during active disease and after achieving clinical remission. Patients and methods Forty children with newly diagnosed ALL on the basis of history, physical examination, and blood and bone marrow analysis were included in the study. Patients were treated with vincristine, prednisolone, intrathecal methotrexate, l-asparaginase, and adriamycin and followed up for 6 weeks, in order to achieve clinical remission. Twenty healthy children of the same age group were used as the control group. Serum GH and IGF-1 levels of both controls and patients before and after therapy were measured. Results After the diagnosis of ALL and before therapy, GH was found to be nonsignificantly higher compared with healthy controls (8.80 ± 6.80 vs. 5.76 ± 2.77 ng/ml, P = 0.061), but IGF-1 was significantly higher in patients than in controls (233.50 ± 100.1 vs. 179.70 ± 77.94 ng/ml, P = 0.040). After achieving remission with 6 weeks of therapy, GH was found to be highly significantly decreased (2.04 ± 1.31 ng/ml) in patients compared with the level before treatment and compared with the control group (P = 0.0001). Also, IGF-1 was reduced significantly (192.93 ± 81.15 ng/ml) compared with the level before treatment (P = 0.0001) but was nonsignificantly higher compared with the level of the control group (P = 0.569). There was significant correlation between GH and IGF-1 levels in ALL patients before therapy and after achieving remission (P 0.05). Conclusion The higher levels of GH and IGF-1 during active ALL and their reduction after treatment may be helpful in assessing the disease activity and predicting the response to chemotherapy.