DISPROPORTIONATE SHORT STATURE AFTER CRANIAL IRRADIATION AND COMBINATION CHEMOTHERAPY FOR LEUKEMIA

The effect of combination chemotherapy and cranial irradiation on fina l height and body proportions was retrospectively examined in a cohort of 142 children treated for acute lymphoblastic leukaemia (ALL). Eigh ty four children (48 girls, 36 boys) received 24 Gy cranial irradiatio n and 58 (35 girls, 23 boys) 18 Gy. None had received testicular or sp inal irradiation. A significant reduction in standing height SD score from diagnosis to final height was seen in all groups. Of the 109 chil dren in whom sitting height measurements were available, 88 (81%) had relatively shorter backs than legs and in 25 (23%) this disproportion was of a marked degree. After mathematical correction for sitting heig ht loss there was no longer a significant reduction in standing height SD score at final height in all except the 24 Gy group of girls. Thes e data suggest that disproportion is a common finding after treatment for ALL and that, at least in some children, much if not all of the he ight loss seen is due to a reduction in sitting height. Possible expla nations for this disproportion include a disturbance of puberty or an effect of chemotherapy on spinal growth, or both.