Growth patterns in children treated for Acute Lymphoblastic Leukemia (ALL): Relationship with cranial irradiation

none7Reduction of adult height is a well-recognized complication in long-term ALL survivors who received 18 Gy or more prophylactic cranial radiotherapy (RT) during their oncological treatment in childhood. Whether changes in the pubertal timing or obesity play a role in height loss of these subjects is poorly understood. Growth patterns of 74 survivors of childhood leukaemia were analyzed: group A (16M-8F) underwent chemotherapy (CT) plus RT (18Gy); group B (30M-30F) underwent only chemotherapy. Mean age at diagnosis was 6.0±3.2yrs, mean follow-up 10.7±3yrs. Thirty-two pts (16M) had attained final height at the time of evaluation. Height (H), final height (FH), target height (TH), FH-TH, and body mass index (BMI) were evaluated at diagnosis, stop-therapy and yearly until adulthood, and converted to z scores (SD) for age and sex. Bone age (Bayley-Pinneau) and pubertal stage (Tanner) were also assessed. In group A mean FH-SD was lower than H-SD at the end of therapy (p<0.01) whereas in group B this difference was not found. FH-SD was lower (p<0.005) in group A than group B only in females. FH-TH did not differ between the two groups. The onset of puberty in groups A and B did not vary neither between girls (10.1±1.9yrs vs 10.8±0.2yrs), nor between males (12.0±1.1yrs vs 11.5±1.7yrs); mean age of menarche occurred respectively at 12.4±1.2yrs and 11.9±1yr, testicular volume ³15ml was found at 14.8±1.1yrs and 14.9±1.9yrs. Mean BMI-SD of groups A and B did not differ neither between males (0.6±1.2 vs 0.51±0.6), nor between females (-0.42±0.4 vs -0.59±1.9). Males and females submitted to cranial irradiation show a significant height loss during the follow-up, compared to subjects treated only with chemotherapy. Their growth impairment may be not detectable during the early period of follow-up, but only during the pubertal growth spurt. For this reason GH status should be reassessed in all these subjects at puberty.noneA. Pasini;F. Baronio;S. Gualandi;M. Bal;M. Marsciani;G. Maltoni;A. CicognaniA. Pasini;F. Baronio;S. Gualandi;M. Bal;M. Marsciani;G. Maltoni;A. Cicognan