LONGITUDINAL STUDY OF GROWTH IN CHILDREN TREATED FOR ACUTE LYMPHOBLASTIC LEUKEMIA

Abstract

To evaluate growth retardation and obesity in relation to treatment of ALL children in initial remission (7.3 to 17.5 yrs), the heights (HTs) and weights (WTs) of 74 boys and 83 girls diagnosed prior to 1976 were analyzed. Patients were treated with chemotherapy and cranial or craniospinal irradiation (2400 rads) after diagnosis at 0.2 to 16.6 yrs of age (median 4.4). HT and WT are expressed as SD from the mean of the normal population by age and sex (NCHS standards). A decrease in HT SD occurred between diagnosis and last HT recorded for boys (mean ± 1 SD: O.1±1.0 vs -0.9 ±1.2, p<0.001, Wilcoxon) and for girls (-0.1±1.1 vs -1.4±1.2, p<0.001). Boys lost -0.7±0.4 SD in HT during therapy; -0.1±0.6 SD from the end of therapy until age 11.6 yrs; and -0.3±0.7 SD thereafter. Girls lost -0.7±0.6 SD in HT during therapy; 0.0±0.6 SD from end of treatment until 2 yrs prior to menarche, and -0.7±0.9 SD thereafter. 35% of boys and 48% of girls lost ≥1.5 SD in HT during the study period. As an index of appropriateness of WT for HT, HT SD was subtracted from WT SD. For boys, last (WT-HT) SD was 1.3±1.3 compared to -0.2±0.9 at diagnosis; 76.2% had a final positive index of obesity. For girls, last (WT-HT) SD was 1.3±1.2 compared to - 0.2±0.8 SD at diagnosis: 85.7% had a final positive index. Last (WT-HT) SD inversely correlated to last HT SD among girls (r= -0.45, p<0.001 ) but not boys. Additional girls receiving 1800 rads (20) or no rads (23) were compared to girls receiving 2400 rads for change in HT during treatment and a difference was found (-0.4±0.6 vs -0.3±0.6 vs -0.7±0.6, respectively, p<0.02, ANOVA); no difference was found with similar groups of\boys. In conclusion, many long-term survivors of ALL develop linear growth retardation and obesity. Much of the height loss occurs during therapy and may be related to radiation; an adequate “catch-up” phase of growth does not occur.