Related Experiment Videos
An anthropometric study of children during intensive chemotherapy for acute lymphoblastic leukaemia
S F Ahmed1, W H Wallace, C J Kelnar
1Department of Child Life and Health, University of Edinburgh, UK. sahmed@hgmp.mrc.ac.uk
Insights
Cytotoxic chemotherapy for acute lymphoblastic leukaemia (ALL) significantly impacts prepubertal children's growth, causing temporary reductions in height and sitting height. Some recovery is observed before treatment completion.
Area of Science:
- Pediatric Oncology
- Growth and Development Studies
- Clinical Research
Background:
- Cytotoxic chemotherapy (CT) is a cornerstone treatment for acute lymphoblastic leukemia (ALL).
- The impact of intensive CT on growth in prepubertal children requires detailed investigation.
- Understanding short-to-medium term growth effects is crucial for managing pediatric ALL patients.
Purpose of the Study:
- To evaluate the short-to-medium term effects of cytotoxic chemotherapy (CT) on the growth of prepubertal children with acute lymphoblastic leukemia (ALL).
- To analyze changes in weight (Wt), height (Ht), sitting height (SH), and body mass index (BMI) during and after CT.
- To assess potential recovery patterns in growth parameters before the completion of chemotherapy.
Main Methods:
- A prospective study involving 31 prepubertal children undergoing intensive CT for ALL.
- Monthly measurements of Wt, Ht, SH, and BMI, presented as changes in standard deviation scores (delta SDS) from baseline.
- Exclusion of children with specific conditions like Down's syndrome or cranial irradiation to isolate CT effects.
Main Results:
- A significant nadir in height SDS was observed at 6 months (median delta SDS-Ht: -0.35, p=0.001).
- Sitting height SDS showed a significant reduction at 3 months (median delta SDS-SH: -0.55, p=0.02).
- Weight SDS and BMI SDS showed transient increases early in treatment, with BMI SDS remaining elevated at 10 months, indicating a relative delay in height recovery compared to weight.
Conclusions:
- Intensive cytotoxic chemotherapy for childhood ALL adversely affects prepubertal growth, particularly height and sitting height.
- While growth is impacted, there is evidence of some recovery in growth parameters before the conclusion of CT.
- The findings highlight the need for monitoring growth during and after ALL treatment to manage potential long-term sequelae.
Abstract:
In order to study the short-to medium-term effects of cytotoxic chemotherapy (CT) for acute lymphoblastic leukaemia (ALL) on growth in prepubertal children, a prospective study of weight (Wt), height (Ht), sitting height (SH) and body mass index (BMI) was performed in 31 children receiving intensive CT for ALL. Two pubertal children, 1 child with Down's syndrome and 3 children who had cranial irradiation were excluded from the analysis. Monthly measurements were presented as change in standard deviation scores from baseline (delta SDS). The median age at diagnosis was 4.4 years (range, 1.1-14). The median duration of study per subject was 18 months (3-24). The median delta SDS-Ht reached a nadir of -0.35 at 6 months after the start of CT (p = 0.001, Wilcoxon signed rank test); the median delta SDS-SH was -0.55 at 3 months (p = 0.02); the median delta SDS-Wt and delta SDS-BMI increased at 2 months to 0.15 (p = 0.03) and 0.5 (p = 0.002), respectively. The median delta SDS-BMI was also elevated at 10 months (0.75, p = 0.01) reflecting the relative delay in recovery of Ht-SDS in comparison to Wt-SDS. The median SH:Ht ratio, a measure of disproportion, was reduced at 3 months (delta SH:Ht ratio, -0.01, p = 0.009). No significant changes in Ht-SDS, BMI-SDS or SH:Ht from baseline were evident at the end of the CT. Cytotoxic CT for ALL in childhood has a significant adverse effect on growth, but there is some evidence for recovery before the end of CT.