Growth and puberty in children after treatment of acute lymphoblastic leukemia

BACKGROUND: Growth retardation and other endocrine abnormalities were recognized as sequelae of therapy of acute lymphoblastic leukemia (ALL), especially when chemotherapy was combined with cranial irradiation. The aim of our study was to establish growth and pubertal development in the group of children who had been previously successfully treated for ALL. METHODS AND RESULTS: 58 children (30 F, 28 M, age 8-18 y.) in complete initial remission lasting 4-15 y. (m 8 y.) after standard antileukemic therapy (including cranial irradiation) completed 2-9 y. ago (m 3 including y.) were studied. Standard deviation score (SDS) of standing height (SH) to chronological age (CA) and to genetic target height (GTH), index of body proportionality and timing of puberty were followed up. The final height attained 21 girls and 3 boys. The height of the boys differed neither from the average for our men, nor from their GTH. Girls: SH 148 cm-169 cm, SH of 7 girls > or = -1.5 SDS, 8 girls > or = -1.5 SDS to their GTH. The final height didn't reach yet 23 boys and 9 girls. Their SH to CA as well as SH to GTH didn't substantially differ from average. Index of body proportionality > or = 1.5 SDS in 12/30 girls and 6/28 boys. Menarche was already reached in 25 girls in age ranging from 10-15 y. (mean 11.3 y.), what was less than average for our population (13.3 y.). CONCLUSION: Even the height of prepubertal children under study didn't differ from average, the final height of girls (boys could not be evaluated because of small numbers) was significantly lower as could be expected. We suppose the early ending of puberty as a contributing factor of short stature in girls. Clear tendency to obesity especially among older girls was observed. Children who underwent antileukemic therapy deserve careful endocrinological follow-up.