Height deficit during and many years after treatment for acute lymphoblastic leukemia in children: a review
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Published on: October 17, 2025
Marcos Borato Viana1, Maria Ivone Oliveira Pinto Vilela
1Department of Pediatrics, Federal University of Minas Gerais, Belo Horizonte, Brazil. vianamb@gmail.com
Insights
Chemotherapy for acute lymphoblastic leukemia (ALL) can cause height loss, especially in younger children. Growth hormone therapy may help improve height without increasing relapse risk.
Area of Science:
- Pediatric Oncology
- Endocrinology
- Growth and Development
Background:
- Conflicting data exist regarding height deficits in children with acute lymphoblastic leukemia (ALL).
- Variations in treatment protocols, patient age, and data collection methods contribute to discrepancies.
- Cranial irradiation (CRT) is a significant factor influencing growth outcomes.
Purpose of the Study:
- To review and synthesize existing literature on height deficits in pediatric ALL survivors.
- To identify factors influencing growth outcomes and evaluate the efficacy of growth hormone (GH) therapy.
Main Methods:
- Systematic review of 25 papers published between 1987 and 2006.
- Analysis of data concerning chemotherapy regimens, cranial irradiation, patient demographics, and growth measurements.
Main Results:
- Chemotherapy consistently causes height reduction during treatment, with or without CRT.
- Catch-up growth is observed post-treatment, but intensive chemotherapy alone leads to long-term height decrease.
- Younger children and girls appear more susceptible to severe height deficits, though confounding factors need consideration.
- Growth hormone deficiency is common, particularly after CRT, and GH replacement therapy shows efficacy.
- GH therapy does not appear to increase the risk of ALL relapse.
Conclusions:
- Height deficits are a significant concern in pediatric ALL survivors, influenced by treatment intensity and patient age.
- Growth hormone therapy is a viable option for addressing height loss in these children.
- Further research is needed to clarify sex-based differences and optimize growth-restoring interventions.
Abstract:
There are conflicting data on the incidence and severity of height deficits in children with acute lymphoblastic leukemia (ALL). This is probably due to: (1) collection of data in different phases of treatment; (2) differences in chemotherapeutic regimens; (3) inclusion or not of children who had received cranial irradiation (CRT); (4) limited numbers of patients; (5) relative numbers of prepubertal and pubertal children; (6) different ways of measuring growth deficits. Twenty-five papers published between 1987 and 2006 were reviewed. These reveal that (1) chemotherapy always causes some height reduction during treatment regardless of whether additional CRT is given; (2) catch-up growth occurs immediately after cessation of treatment; (3) intensive chemotherapy alone significantly decreases height in the long-term but to a lesser extent than with additional CRT; (4) young children develop more severe height loss; (5) girls are reported to have greater height deficits but confounding factors have not been adequately considered; (6) late growth hormone (GH) deficiency has been detected in many children, mostly in those who had CRT; (7) GH replacement therapy seems to be effective. ALL relapse in GH-treated children is not more common than in those not treated with GH.
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