LONG-TERM EFFECTS OF TREATMENT FOR ACUTE LYMPHOBLASTIC-LEUKEMIA WITH AND WITHOUT CRANIAL IRRADIATION ON GROWTH AND PUBERTY - A COMPARATIVE-STUDY

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.