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Growth in children treated for acute lymphoblastic leukemia with and without prophylactic cranial irradiation
Insights
Prophylactic cranial irradiation significantly impacts growth in children treated for acute lymphoblastic leukemia. Non-irradiated children showed better height and weight gain over four years, suggesting irradiation causes growth inhibition.
Area of Science:
- Pediatric Oncology
- Endocrinology
- Hematology
Background:
- Children undergoing treatment for acute lymphoblastic leukemia (ALL) often experience growth disturbances.
- Cranial irradiation is a common treatment modality, but its long-term effects on growth are a concern.
Purpose of the Study:
- To investigate the longitudinal effects of prophylactic cranial irradiation on growth and weight gain in children treated for acute lymphoblastic leukemia.
- To compare growth patterns between children who received cranial irradiation and those who did not.
Main Methods:
- A longitudinal study over four years involving thirty-nine children treated for acute lymphoblastic leukemia.
- Children were divided into two groups: 28 received prophylactic cranial irradiation, 11 did not.
- Growth and weight gain were monitored, and standard deviation scores (SDS) were calculated.
Main Results:
- Children treated without cranial irradiation exhibited significantly higher height growth rates in the fourth year (p < 0.01).
- After four years, attained height declined by 0.5 SD in the irradiated group versus 0.2 SD in the non-irradiated group.
- The non-irradiated group showed greater weight gain (0.4 SD more) after four years, with significant weight velocity differences observed in both groups at different time points.
Conclusions:
- Prophylactic cranial irradiation appears to be a major contributor to prepubertal growth inhibition in children treated for acute lymphoblastic leukemia.
- Avoiding cranial irradiation may lead to improved long-term height and weight outcomes in pediatric ALL survivors.
- Further research into growth-sparing strategies for ALL treatment is warranted.
Abstract:
Growth and weight gain were studied longitudinally over a period of four years in thirty-nine children treated for acute lymphoblastic leukemia. The children were divided into two groups according to treatment. Twenty-eight children were given prophylactic cranial irradiation and eleven children were treated without such irradiation. The duration of cytostatic treatment was three years in all cases. Average growth during the first two years was similar in the two groups, and the standard deviation scores (SDS) were below average. The rate of growth (in height) during the fourth year was significantly higher among those children who had not received cranial irradiation (p less than 0.01). After four years the average attained height had declined 0.5 SD for children treated with cranial irradiation and 0.2 SD for children without such treatment. Weight velocity was significantly greater than the expected mean in the non-irradiated group during the first year and in the irradiated group during the fourth year of the study. Attained weight after four years had increased 0.4 SD more among those children who had not received irradiation. The results suggest that prophylactic cranial irradiation is responsible for the greater part of the prepubertal growth inhibition in these children.