LONGITUDINAL GROWTH AND FINAL HEIGHT IN LONG-TERM SURVIVORS OF CHILDHOOD LEUKEMIA

Survival of children with acute lymphoblastic leukaemia (ALL) has incr eased considerably in recent years and data on the spontaneous growth and final height of these children are conflicting. Therefore, we anal ysed the longitudinal growth and final height in 52 survivors (33 fema les, 19 males) of childhood ALL. These children were diagnosed and tre ated in a single institution, all remained in first remission and were submitted to cranial irradiation with either 2400 or 1800 cGy. None o f the patients received testicular or spinal irradiation. Median age a t diagnosis was 4.2 (range 1.3-9.6) years in the first group (2400 cGy ) and 3.9 (0.8-10.5) years in the second (1800 cGy). Standing height w as measured at diagnosis, at the end of treatment (median 3.1 years af ter diagnosis), 6, 12, 24 months after the end of treatment, and final ly at the completion of growth. In girls a significant decrease of mea n height standard deviation score (SDS) during treatment and a catch u p in growth after the end of therapy was followed by a second period o f reduced growth. Mean final height SDS was significantly lower than t he value at diagnosis in both groups of girls, but only in males treat ed with 2400 cGy. Mean overall loss in height SDS from diagnosis to fi nal heigth was higher in females (-1.24) than in males (-0.40) (P =0.0 09). Females less than or equal to 4 years of age at diagnosis showed a higher loss in final height than females > 4 years. An unchanged or improved final height was evident in 8 cases, the other 44 cases showe d a final height decrease between -0.1 and -2 SDS in 36 and > -2 SDS i n 8, 6 of whom were females less than or equal to 4 years at diagnosis and only 1 a female > 4 years. Only females treated at a younger age showed a final height lower than mid-parental height (-5.7 +/- 1.8 cm, P < 0.01), particularly those treated with 2400 cGy (-7.5 +/-2.5 cm, P < 0.05). Menarche occurred earlier than in the normal population (11 .5 +/- 1.2 years) with no differences between the two radiation dosage s. Females, notably young girls, treated for ALL show a greater decrea se in the final height than treated males. Early sexual maturation may contribute to the decrease in the final height. A better growth patte rn seems to be shown by patients irradiated with the lower dosage.