Impact of treatment on the growth of children treated for acute lymphoblastic leukemia

Abstract

Background: Endocrine disturbances are frequent long-term complications of acute lymphoblastic leukemia (ALL) treatment. Research on the risk of impaired linear growth and overweight has reported conflicting results. Procedure: A longitudinal, retrospective study for the characterization of growth (height and body mass index (BMI)) was performed, based on the clinical records of patients treated for ALL since 2003 and off treatment for a minimum of two years. Data on height and weight were collected at diagnosis (0M) and at 6, 12, 24 and 48 months (M), as well as the most recent height (FH). Effects of cranial radiotherapy (CRT) and sex on growth changes were evaluated. FH was compared with target height (TH). Results: 78 patients (52.5% males) met the inclusion criteria. CRT was used in 28.2%. Height percentile (HP) was reduced at 6M reaching a minimum at 12M; this recovered at 48M, but was still inferior to diagnosis for females and most significantly in the CRT group. Diagnosis HP was in general higher than TH. Overweight/obesity affected 21.8% patients at 0M, 45.9% at 12M and 71.4% at 24M. BMI percentile (BP) decreased from 24M to 48M but was still higher than at 0M. The CRT-group had no significant decrease in BP from 24M to 48M. Conclusions: ALL treatment affected linear growth and caused an increase in BMI, with a higher impact on CRT-treated patients for both studied parameters and in females only for height. FH appeared not to be inferior to patient's genetic potential. BMI remained increased after treatment.