Longitudinal Linear Growth and Final Height is Impaired in Childhood Acute Lymphoblastic Leukemia Survivors after Treatment without Cranial Irradiation - 22/06/13

Doi : 10.1016/j.jpeds.2012.12.037

Els Vandecruys, MD ^1,^⁎ , Catharina Dhooge, MD, PhD ¹, Margarita Craen, MD ², Yves Benoit, MD, PhD ¹, Jean De Schepper, MD, PhD ²
¹ Department of Pediatric Hemato-Oncology, Ghent University Hospital, Ghent, Belgium
² Department of Pediatric Endocrinology, Ghent University Hospital, Ghent, Belgium

^∗Reprint requests: Els Vandecruys, MD, Department of Pediatric Hemato-Oncology, Ghent University Hospital, De Pintelaan 185, 9000 Ghent, Belgium.

Abstract

Objective

To evaluate long-term growth and final height (FH) in survivors of childhood acute lymphoblastic leukemia (ALL) who were treated without cranial radiation therapy and underwent evaluation of growth hormone (GH) status at the end of treatment.

Study design

Data on longitudinal growth (collected at the start of treatment, end of treatment, and 1 year thereafter) and FH of 67 adult survivors of childhood ALL who had been treated according to European Organisation for Research and Treatment of Cancer 58831/2 protocols with chemotherapy as the only treatment modality were reviewed retrospectively. Height data were expressed as SDS for national references. The relative role of sex, age at diagnosis, intensity of chemotherapeutic regimen, and GH status at the end of treatment as contributing factors were analyzed.

Results

A modest but significant loss in FH (change in SDS [ΔSDS] = −0.59 ± 0.86; P < .001) was found. Two-thirds of the height deficit observed from diagnosis until FH occurred during treatment. The height deficit was more severe in the male patients (P = .036). The ΔSDS for height from diagnosis to FH was not correlated with age at diagnosis or intensity of treatment. No correlation was found between the results of the GH stimulation test and ΔSDS for height from diagnosis or the end of treatment to FH.

Conclusion

Adult survivors of childhood ALL treated with chemotherapeutic regimens of moderate intensity without cranial radiation therapy exhibit a modest loss in SDS for height at FH irrespective of GH status at the cessation of treatment.

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Keyword : 6-MP, ALL, CNS, CRT, EORTC, FH, GH, GHD, IT, IV, MTX