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Pre-clinical Evaluation of Tyrosine Kinase Inhibitors for Treatment of Acute Leukemia
Published on: September 18, 2013
Analysis of growth failure in children treated for acute lymphoblastic leukemia
1Department of Pediatrics, University of Tokushima, Japan.
Insights
Chemotherapy for acute lymphoblastic leukemia may temporarily impact child growth and puberty, especially in those treated before age 9. Most patients experienced catch-up growth after treatment completion.
Area of Science:
- Pediatric Oncology
- Endocrinology
- Hematology
Background:
- Children with acute lymphoblastic leukemia (ALL) undergo intensive treatments.
- Long-term effects on growth and development require careful monitoring.
Purpose of the Study:
- To evaluate growth patterns in children with ALL after 1 year of remission.
- To assess the impact of chemotherapy and central nervous system (CNS) prophylaxis on growth.
Main Methods:
- Surveyed growth in 303 children with ALL in continuous remission.
- Analyzed data based on risk features (low, intermediate, high).
- Compared effects of cranial irradiation and high-dose methotrexate for CNS prophylaxis.
Main Results:
- Growth failure (<-2 SD) observed in 2/205 low/intermediate-risk and 13/98 high-risk patients.
- Growth failure predominantly affected prepubertal children over 9 years old.
- Temporary growth impairment and delayed puberty noted, with subsequent catch-up growth in most.
Conclusions:
- Chemotherapy may cause temporary prepubertal growth failure and gonadal impairment in ALL survivors.
- Cranial irradiation showed no clear correlation with growth failure in this study.
- Long-term follow-up is needed to fully assess irradiation effects on growth.
Abstract:
Growth patterns were surveyed in 303 children with acute lymphoblastic leukemia who had remained in continuous first complete remission for a minimum of 1 year (median 3 years). Chemotherapy was given for 3 years, and central nervous system prophylaxis consisted of cranial irradiation at a total dose of 18 Gy or intravenous high-dose methotrexate (1.5-6 g/m2 for three to six doses). Intensive chemotherapy, including cyclophosphamide, doxorubicin, and cytosine arabinoside was given to children with high-risk features. Two of 205 children with low- or intermediate-risk features and 13 of 98 children with high-risk features showed a decrease in the growth rate of less than -2 SD. In 14 of these 15 patients, the age at onset was over 9 years and growth failure became most predominant in the prepubertal period: ten of these children showed a tendency toward delayed pubertal development, but eight showed later catch-up growth with pubertal maturation after completion of chemotherapy. Thus, chemotherapy appeared to contribute temporarily to the growth failure and gonadal impairment that occurred in the prepubertal period. No obvious correlation between the administered cranial irradiation and growth failure was found, but further study with a longer follow-up will be necessary to determine the long-term effects of irradiation on subsequent growth patterns in children.
