Background: Childhood acute lymphoblastic leukemia (ALL) survivors are at increased risk for endocrine late effects.
Objective and hypotheses: To evaluate growth and pubertal patterns in patients diagnosed with childhood ALL and to identify risk factors for impaired growth and puberty.
Method: Retrospective chart review with longitudinal assessment of anthropometric measurements and pubertal status of 183 childhood ALL survivors diagnosed between 1985 and 2011 (154 chemotherapy-treated and 29 chemotherapy+cranial radiation-treated; mean age at therapy 6.26±3.8 years and 6.5±4.34 years, respectively). Included in the study were patients aged 830 years at data collection, disease-free>one year, who remained in first remission, with ≥3 years follow-up.
Results: Median age at last endocrine visit was 16.1 years (range 8.227.6 years); median duration of follow-up was 8.7 years (range 321.4 years). Mean age at pubertal onset was normal (girls: 10.3±1.3 years; boys: 12.0±1.3 years); precocious puberty was diagnosed in 8.7% of patients. Overweight and obesity were found in 22.9% and 9.3% of the cohort, respectively. Patients treated with chemotherapy+cranial radiation as compared to chemotherapy-alone were shorter (mean height-SDS −0.93±0.92 vs. −0.21±1.1, P=0.001), had higher prevalence of adult short stature (13% vs. 2.2%) and had a higher rate of precocious puberty in girls (30% vs. 9.4%) with no difference in age at menarche. Predictors for occurrence of endocrine disorders included: female gender (OR 3.26, 95% CI 1.0410.1), cranial irradiation treatment (OR 3.96, 95% CI 1.1413.78) and younger age at diagnosis (OR 0.83, 95% CI 0.681.02). Predictors for obesity - a higher BMI-SDS at diagnosis (OR 1.46, 95% CI 1.181.81), and for short stature - lower height-SDS at diagnosis (OR 0.35, 95% CI 0.130.94).
Conclusion: Although most patients treated with chemotherapy-alone attained normal adult height & puberty, those treated with adjuvant cranial irradiation are at increased risk for short stature and precocious puberty (in girls). Childhood ALL survivors are also at an increased risk for overweight, especially those with increased BMI at diagnosis. Therefore, clinicians need increased awareness & screen for overweight & its associated health conditions early in survivorship. Interventions as changes in lifestyle habits are required to address weight control early during treatment.
10 - 12 Sep 2016
European Society for Paediatric Endocrinology