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Influence of treatment modalities on prepubertal growth in children with acute lymphoblastic leukemia
J J Groot-Loonen1, B J Otten, M A van't Hof
1Department of Pediatric Oncology, University of Nijmegen, The Netherlands.
Insights
Cranial irradiation and intensive chemotherapy in children with acute lymphoblastic leukemia can cause growth retardation. Combining these treatments showed a synergistic negative effect on statural growth.
Area of Science:
- Pediatric Oncology
- Endocrinology
- Radiation Oncology
Background:
- Acute lymphoblastic leukemia (ALL) is a common childhood cancer.
- Treatment protocols for ALL often involve interventions that can impact growth.
- Central nervous system (CNS) prophylaxis is crucial for preventing leukemia recurrence but may affect growth.
Purpose of the Study:
- To evaluate the long-term statural growth in prepubertal children treated for ALL.
- To assess the impact of different CNS prophylaxis methods (cranial irradiation doses) on growth.
- To determine the influence of leukemia risk stratification on growth patterns.
Main Methods:
- Longitudinal study over 4.5 years involving 85 prepubertal children with ALL.
- Patients categorized by CNS prophylaxis: cranial irradiation (24 Gy or 18 Gy) or no irradiation.
- Patients also grouped by leukemia risk: normal-risk (n=74) and high-risk (n=11).
Main Results:
- All patients exhibited growth retardation during the 2-year treatment period.
- Irradiated patients showed a greater decline in height standard deviation score (-0.7) compared to non-irradiated patients (-0.2).
- No significant growth difference was observed between 18 Gy and 24 Gy cranial irradiation, nor between normal-risk and high-risk chemotherapy protocols, but a synergistic negative effect was noted for combined intensive chemotherapy and cranial irradiation.
Conclusions:
- Cranial irradiation significantly impacts statural growth in children treated for ALL.
- The intensity of chemotherapy combined with cranial irradiation has a synergistic detrimental effect on growth.
- Further research is needed to mitigate growth deficits in pediatric ALL survivors.
Abstract:
The statural growth of 85 prepubertal children treated for acute lymphoblastic leukemia was evaluated in a longitudinal study over 4.5 years. Patients were divided into three groups according to central nervous system prophylaxis: 37 patients received cranial irradiation with a dose of 24 Gy, 15 received a dose of 18 Gy, and 33 were not irradiated. According to the risk of leukemia, patients were divided into normal-risk (n = 74) and high-risk (n = 11) groups. The duration of treatment was 2 years, during which all patients showed growth retardation. The relative standard deviation score for height declined from 0 to -0.7 for the irradiated patients and from 0 to -0.2 for the non-irradiated group (P = 0.0001). There was no difference in growth pattern between cranial irradiation with 18 versus 24 Gy and chemotherapeutic treatment according to high-risk versus normal-risk protocols. However, a negative synergistic effect of more intensive chemotherapy and cranial irradiation on growth was demonstrated.