Longitudinal growth in children with non‐Hodgkin's lymphoma and children with acute lymphoblastic leukemia: Comparison between unirradiated and irradiated patients

Abstract

Longitudinal growth was studied in children treated for non-Hodgkin's lymphoma (NHL). The aim of the study was to compare these children's growth velocity with findings in a previous study we performed on age-matched children with acute lymphoblastic leukemia (ALL) who received cranial irradiation. Nine children with NHL with an onset time of treatment between 4 and 9 years of age (mean 6.5 years) were studied with annual body measurements taken from the time of the diagnosis and thereafter annually during the following 4 years. None of the children received cranial irradiation. During the first treatment year a significantly low mean height velocity was observed (-1.4 standard deviation score [SDS]) for the NHL group. The consecutive two 1 year periods showed a normalization of the mean height velocity. For the group of children with ALL, there was a more prominent negative effect on height during the first 2 years of treatment than for the NHL group in the present study. After the cessation of therapy, the children with NHL showed a reduced catch-up growth compared with the children with ALL. The explanation offered is that cranial irradiation has a heavier impact on growth than chemotherapy during the first 2 years of treatment, but an intense chemotherapy during the maintenance period could have a considerable impact in blunting growth.

Growth and growth hormone secretion in children with cancer treated with chemotherapy

“…However, some authors have indeed observed such correlation. 15,16,18 We did not observe relationships between duration of follow-up, type of tumor, sex, age at diagnosis, and abovementioned parameters. Other authors have observed greater growth impairments in the youngest patients 10,18 and in girls.…”

“…Furthermore, the issue has almost always been approached indirectly because, in the majority of cases, chemotherapy is an integral part of a combined treatment program with radiotherapy, [7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22] and for this reason the results of such studies are not entirely comparable with ours. These studies attribute a negative influence of chemotherapy on growth on the basis of the following observations: patients treated with longer or more intensive courses of chemotherapy exhibit less growth than those treated with shorter or less intense regimens, 10,15,16,18 and patients treated with both radiotherapy and chemotherapy have less growth than those treated exclusively with radiotherapy. 17 In most of these studies, an influence of chemotherapy on growth parameters (height/growth rate) was observed, whether as a reduction in the growth rate during chemotherapy followed by catchup growth 9, 12-14, 20-22 or in a "chronic" form with absent or reduced subsequent recovery.…”

“…17 In most of these studies, an influence of chemotherapy on growth parameters (height/growth rate) was observed, whether as a reduction in the growth rate during chemotherapy followed by catchup growth 9, 12-14, 20-22 or in a "chronic" form with absent or reduced subsequent recovery. 7,10,[15][16][17][18] Some studies have found no significant influence of chemotherapy on grovvth. 8,11,19 It is probable that differences in drug regimens may account for reported variations in the incidence and severity of growth retardation in patients treated with chemotherapy 12,13,20 In our study, as in some others, 12 growth parameters (height/growth rate) were not correlated with duration of treatment or intensity of chemotherapy.…”

“…9,[12][13][14][15]18,21,24 Various explanations have been proposed including (1) the disease process itself, (2) an increase in nutritive requirements, (3) malnutrition during treatment, (4) infections, (5) vomiting, (6) the treatment (chemotherapy, radiothera-py, corticoids) and, (7) combinations of the aboye factors. However, a persistent reduction in growth rate after cessation of chemotherapy is difficult to explain 2,10,[15][16][17][18] except in cases in which the tumor or the treatment produce or provoke important late effects. Studies to date attribute this persistent reduction in growth rate to (1) prolonged treatment with corticoids, (2) radiotherapy/chemo-therapy synergism, (3) GHD as a result of cranial radiotherapy, (4) intensity and duration of chemotherapy, or (5) reduced peripheral tissue response to growth factors.…”

Bone Turnover and Growth During and After Continuing Chemotherapy in Children with Acute Lymphoblastic Leukemia

“…There have been many reports of poor growth in children with acute lymphoblastic leukemia (ALL), especially during periods of intensive chemotherapy, but growth may return to normal during less-intensive periods and may show evidence of further catch-up after completion of chemotherapy (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13). Of greater concern are a number of retrospective crosssectional studies on survivors of ALL that describe reduced bone mineral density (BMD) at various sites (14 -16).…”