Acs. Hokkenkoelega et al., LONG-TERM EFFECTS OF TREATMENT FOR ACUTE LYMPHOBLASTIC-LEUKEMIA WITH AND WITHOUT CRANIAL IRRADIATION ON GROWTH AND PUBERTY - A COMPARATIVE-STUDY, Pediatric research, 33(6), 1993, pp. 577-582
We investigated the comparative effect on long-term growth of CNS prop
hylactic treatment for acute lymphoblastic leukemia (ALL) with either
25-Gy cranial irradiation or moderate-dose i.v. methotrexate. In 80 ch
ildren with complete continuous first remission, data on growth and pu
bertal development were investigated up to 11 y from ALL diagnosis. Fo
rty patients had 25-Gy cranial irradiation, 16 of them with high-risk
factors and 24 without. Another 40 non-high-risk ALL patients had mode
rate-dose methotrexate. Chemotherapy lasted 3 1/4 y for high-risk ALL
patients and 2 1/4 y for those not at high risk. Pubertal development
and final height were assessed separately for girls diagnosed before o
r after age 7 and for boys before or after age 9. All patients had a s
imilar decline in height SD score during the first 6 mo of treatment,
which persisted in irradiated children only. The nonirradiated group h
ad no further decline. Catch-up growth only started when chemotherapy
ended for irradiated and nonirradiated patients alike. Five y after ce
ssation of treatment, changes in height SD score for nonirradiated chi
ldren remained within the range for healthy children against a signifi
cant decline in height SD scores for irradiated children. Pubertal dev
elopment in irradiated girls diagnosed before age 7 was within normal
range, but their final height was disappointing due to a blunted growt
h spurt. In contrast, irradiated girls diagnosed later had a delayed o
nset of puberty but satisfactory final height. Comparable results were
found in boys. In summary, 25-Gy cranial irradiation in the treatment
of ALL causes long-term growth retardation, whereas moderate-dose i.v
. methotrexate seems to have only a temporary effect on growth.