Background: Adult survivors of childhood Acute Lymphoblastic Leukemia (ALL) treated with protocols including cranial radiotherapy (CRT) demonstrate a persistent increased BMI and a reduced final height (FH).
Objective and hypotheses: We investigated the effect of chemotherapy alone (CT) on BMI and FH in an international cohort of childhood ALL survivors.
Method: English patients (61% female) treated on UKALL XI protocol without CRT and 107 Italian patients (46% female) treated on AIEOP 87-2000 protocols were included in the study. Height- and BMISDS were collected at: diagnosis (dT); end of CT (eT); FH. All Italian survivors and 54% of English population were exposed to i.v. high dose methotrexate (MTX).
Results: Although survivors were not clinically short at FH, all Italian patients and English females experienced a loss of heightSDS during CT not followed by a complete catch-up growth (heightSDS: Italian female: dT 0.60±1.05, eT 0.19±1.09° (°significant difference vs dT), FH 0.07±1.25°; English female: dT 0.22±1.05, eT 0.00±0.90°, FH −0.02±0.84°; Italian male: dT 0.62±1.05, eT 0.30±1.09°, FH 0.27±1.03°; English male: dT 0.17±1.17, eT 0.10±1.13, FH 0.11±1.04). BMI-SDS increased during CT in all females and Italian males (BMISDS: Italian female: dT −0.12±1.31, eT 0.29±1.36°, FH 0.54±0.96°; English female: dT 0.14±1.25, eT 0.71±1.11°, FH 0.41±1.43; Italian male: dT 0.39±1.30, eT 0.82±1.29°, FH 0.49±1.09; English male: dT 0.48±1.38, eT 0.75±1.07, FH 0.25±1.38). Only Italian females showed a significant increase in BMI-SDS at FH compared with dT.
Conclusion: CT alone minimizes the loss in FH SDS together with the increase in BMI SDS in adult survivors of childhood. Females seem more susceptible to CT effects, especially when exposed to high dose MTX.
20 - 22 Sep 2014
European Society for Paediatric Endocrinology