Impaired pubertal growth in acute lymphoblastic leukaemia

• Published in: Archives of disease in childhood 1991-12, Vol.66 (12), p.1403-1407
• Main Authors: Uruena, M, Stanhope, R, Chessells, J M, Leiper, A D
• Format: Article
• Language: English
• Subjects: Acute lymphoblastic leukemia; Acute lymphocytic leukemia; Age; Age Factors; Biological and medical sciences; Body Height - radiation effects; Brain Injuries; Care and treatment; Chemotherapy; Child; Childhood leukemia; Children; Children & youth; Complications; Cranial Irradiation; Diagnosis; Dwarfism; Endocrine disorders; Female; Females; Growth hormones; Hematologic and hematopoietic diseases; Humans; Irradiation; Leukemia; Lymphoblastic leukemia in children; Male; Males; Medical sciences; Methotrexate; Pediatrics; Precursor Cell Lymphoblastic Leukemia-Lymphoma - radiotherapy; Puberty; Puberty - radiation effects; Radiation therapy; Radiotherapy; Radiotherapy - adverse effects; Radiotherapy Dosage; Remission; Retrospective Studies; Risk factors; Sex Factors; Skull
• ISSN: 0003-9888; 1468-2044
• DOI: 10.1136/adc.66.12.1403

The growth of 182 patients who were long term survivors of childhood acute lymphoblastic leukaemia was retrospectively analysed. All remained in first remission and were treated with either 1800 or 2400 cGy of cranial irradiation. None had been treated with either testicular or spinal irradiation. Ninety three (51 boys, 42 girls) were treated with 2400 cGy and 89 (42 boys, 47 girls) were treated with 1800 cGy cranial irradiation. All patients were treated with standard chemotherapy including intrathecal methotrexate in similar dose regimens in either group. Mean age (SD) at diagnosis in the group treated with 2400 cGy was 4.8 (2.6) years and mean age in the group treated with 1800 cGy was 6.5 (3.3) years. Mean height SD score at diagnosis in the 2400 cGy group was +0.29 and final height achieved was -0.63. Mean height SD score at the start of treatment in the group treated with 1800 cGy was +0.40 and mean final height was -0.53. There was a similar reduction in height SD score in both groups during the pubertal growth spurt. The decrement in height SD score was greater when treatment was administered at less than 7 years of age in either dose regimen, both in prepubertal and pubertal growth. However, the decrease in height SD score was found to be greater in girls than boys. There was a trend in both sexes for the onset of puberty to be at a younger age with a lower treatment dose of radiotherapy. However, in girls treated with the lower dose regimen there was a significant reduction in the mean age of onset of puberty which was 9.9 years. Our data suggest that girls treated at less than 7 years of age have a severe impairment of pubertal growth, which is probably a combination of the dual endocrinopathy of premature puberty and growth hormone insufficiency.