Related Experiment Videos
Growth in Children Treated for Acute Lymphoblastic Leukemia: Single Institution Report from North India
Pankaj Kumar1, Amita Trehan2, A K Bhalla1
1Department of Pediatrics Advanced Pediatric Centre, Postgraduate Institute of Medical Education & Research, Chandigarh, 160012 India.
Insights
Childhood leukemia survivors experience impaired growth due to intensive therapy. While catch-up growth occurs after treatment, children with acute lymphoblastic leukemia (ALL) often remain shorter than their peers.
Area of Science:
- Pediatric Oncology
- Growth and Development
- Clinical Nutrition
Background:
- Survivors of childhood acute lymphoblastic leukemia (ALL) face long-term risks of impaired growth and short stature.
- Intensive combination chemotherapy and radiation therapy are primary contributors to these growth disturbances.
- Understanding anthropometric changes is crucial for monitoring and managing long-term health outcomes in ALL survivors.
Purpose of the Study:
- To evaluate anthropometric parameters (height, weight, BMI) in children treated for acute lymphoblastic leukemia (ALL).
- To assess changes in Z-scores for height, weight, and BMI at various stages of treatment and post-treatment.
- To compare growth patterns with established growth standards for Indian children.
Main Methods:
- A cohort of 52 boys and 21 girls treated for ALL and off-treatment for at least 2 years were analyzed.
- Height, weight, and Body Mass Index (BMI) were measured at induction, 6 months, end of treatment, and 2 years post-treatment.
- Z-scores were calculated and changes analyzed using CDC criteria and Agarwal standards.
Main Results:
- Height and weight Z-scores significantly decreased during the intensive therapy phase.
- Catch-up growth was observed after treatment cessation, but patients remained shorter overall.
- Girls under 9 years showed significantly reduced height; BMI Z-scores increased throughout the study.
Conclusions:
- Acute lymphoblastic leukemia (ALL) therapy significantly impacts anthropometric variables, with maximum growth deceleration during intensive treatment.
- While catch-up growth occurs post-therapy, survivors tend to be smaller than their peers.
- Long-term monitoring of growth parameters is essential for childhood leukemia survivors.
Abstract:
Survivors of childhood leukemia are at risk of impaired growth and short stature as adults due to intensive combination chemotherapy and radiation injury. This study was undertaken to evaluate anthropometry in children treated for acute lymphoblastic leukemia (ALL). Children treated for ALL and off treatment for a minimum period of 2 years were evaluated for height, weight and BMI. Z scores were calculated for height, weight and BMI: at induction, 6 months after starting treatment, at end of treatment and at 2 years after completion of therapy. Change in z scores were calculated and compared with CDC criteria and Agarwal standards for Indian children. Fifty two boys and 21 girls were analyzed. Height and weight z scores were seen to show a steep decrease during the initial intensive phase of therapy. The gain in height and weight continued to be slow during therapy and catch up occurred after cessation of therapy. On completion of therapy, patients were shorter, but not significantly so. Girls <9 years were significantly shorter. Weight remained on the lower side of normal. Change of z scores was statistically significant for weight at end of treatment (p = 0.032) and 2 years after completion of treatment (p = 0.00). BMI z score increased throughout the study period. Peak growth velocities were also late in the study subjects Anthropometric variables of height, weight and BMI are affected by ALL during therapy. Growth deceleration is maximum during the intensive phase of therapy. Catch up growth occurs but children remain smaller than their peers.
