Osteosarcoma Following Growth Hormone Therapy in Recurrent Acute Lymphoblastic Leukemia and Rapadilino Syndrome

Abstract

A 16-year old Caucasian girl was evaluated for scoliosis 9 years after bone marrow transplant (BMT) and 13 years after her initial ALL diagnosis. A chest radiograph showed a lesion of the right third rib. Histopathology was consistent with a high-grade OS. She died 5 months after OS diagnosis. There is no family history of cancer. Prior therapy comprised BFM standard risk for de novo ALL, St. Jude Children’s Research Hospital regimen and cranial-spinal radiation for central nervous system (CNS) recurrence, Children’s Cancer Group (CCG) 1941, and matched unrelated allo-transplant (conditioned with TBI and thiotepa, cyclophosphamide, and ATG) for bone marrow recurrence. Two years after transplant GH therapy commenced. A 15-year-old Hispanic girl with RAPADILINO syndrome experienced left lower extremity pain. Magnetic resonance imaging (MRI) showed a destructive lesion and biopsy was consistent with OS. At 11 years of age short stature was diagnosed. Growth hormone therapy was started and discontinued once OS was diagnosed. There is no family history of cancer. The Childhood Cancer Survivor Study reported the 25-year follow-up among survivors of childhood ALL. The cumulative incidence of SMN of 5.2% (6.2% for those receiving radiation therapy) at 25 years from diagnosis [2]. St. Jude Children’s Research Hospital (SJCRH) investigators reported the incidence of SMN as a first event in 2169 patients treated between 1962 and 1998 [3]. The cumulative incidence of SMN was 4.17% at 15 years and 10.85% at 30 years. Two cases of OS constituting 1.2% of SMN were observed.