Final height and body mass index after treatment for childhood acute lymphoblastic leukemia
Background: Newer and more agressive forms of chemotherapy and newer protocols in the treatment have increased the survival rate of children with malignancies. Improved survival rates in children treated for acute lymphoblastic leukemia have focused attention on late effects including disorders of growth and puberty, and development of overweight or obesity.
Methods: The height and weight expressed as body mass index (BMI) of 47 patients (29 girls, 18 boys) long-term survivors of childhood lymphoblastic leukemia was retrospectively analyzed. Height standard deviation score (HSDS) according to Tanner and body mass index standard deviation scores (BMISDS) before treatment and at follow-up were calculated. At the time of analysis all patients remained in first remission. Twenty-eight patients had cranial radiation with 12–18 Gy and 15 with 20–30 Gy. Four patients had no radiotherapy. All patients were treated with standard chemotherapy including intrathecal Methotrexat. Mean age (SD) at the diagnosis was 5 5/12 (3 2/12) years, range (5/12 – 12 5/12) and at the time of evaluation 17 11/12 (3 9/12) years, range (10 1/12 – 31 6/12).
Results: We observed significant decrease in HSDS from diagnosis to the final height in both radiation groups (p < 0.01) but the decrement in final height was similar with both radiation dose regimens. The decrement in final height SDS was greater in patients treated at a younger age (Pearson, p < 0.01). Girls treated with higher radiation dose (20–30 Gy) were more severely affected than boys. In both radiation dose treatment groups there was a significant increase in BMISDS between diagnosis and final height (p < 0.0001) with no significant difference between treatment groups. Menarche occurred earlier in girls than normal with no significant difference between both radiation dose regimens.
Conclusions: We observed significant deterioration in HSDS and increment in BMISDS regardless to the radiation dose.
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