Reduction 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.
Growth patterns in children treated for Acute Lymphoblastic Leukemia (ALL): Relationship with cranial irradiation
BARONIO, FEDERICO;GUALANDI, STEFANO;BAL, MILVA ORQUIDEA;MALTONI, GIULIO;CICOGNANI, ALESSANDRO
2005
Abstract
Reduction 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.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
