Growth, puberty and obesity after treatment for leukaemia

Abstract

Final height, body proportions, pubertal growth and body mass index were studied retrospectively in 142 survivors of acute lymphoblastic leukaemia (ALL). Treatment consisted of combination chemotherapy and cranial irradiation (18 or 24 Gy). Significant standing height loss and disproportion, with a relatively short back, was seen in both radiation dose groups. Girls were more severely affected than boys. Pubertal growth was adversely affected, with a reduction in peak height velocity in both sexes. Puberty occurred early in girls but at the normal time in boys. Nearly half the group were obese at final height, with no significant difference in incidence between the sexes. The relative roles of cranial irradiation and chemotherapy in the disturbance of growth, puberty and body composition observed in survivors of childhood ALL remain unclear. The aetiology is almost certainly multifactorial, with radiation‐induced growth hormone insufficiency, early puberty, steroids and chemotherapy all having a role.

Anthropometric parameters and their relationship to serum growth hormone-binding protein and leptin levels in children with acute lymphoblastic leukemia: a prospective study

“…The frequency and pattern of obesity in survivors of ALL is less well documented than the effect of this disease on linear growth. Nevertheless, it is calculated that nearly half of the long-term survivors of childhood leukemia are overweight (25,26). Endocrine disorders causing blunted growth, e.g.…”

Obesity in Pediatric ALL Survivors: A Meta-Analysis

“…The prevalence of overweight/obesity ranged between 29% to 69% in 14 studies that Age at study and year since Dx are the mean or median as reported or estimated based on the reported age at diagnosis and duration of follow-up (the mean duration of treatment was estimated to be 2.5 y if not indicated by the study). evaluated pediatric ALL survivors off treatment 5 to 9 years (mean/median age = 13.2-19.4 years) [8][9][10]24,33,[51][52][53][54][55][56][57][58] except for 1 early study published in 1986 59 that reported a prevalence of obesity of 8% ( Table 2). The prevalence of overweight/obesity was fairly consistent in 5 studies that evaluated pediatric ALL survivors off treatment $10 years (mean/median age = 20.5-24.1 years), ranging from 34% to 46% 7,14,40,60,61 (Table 3).…”

“…10,11,14,34,47,51,60 However, the other 15 studies did not find evidence of a gender difference. [6][7][8]12,15,28,31,33,36,38,47,[52][53][54]62 FIGURE 2…”

Growth hormone treatment impact on growth rate and final height of patients who received HSCT with TBI or/and cranial irradiation in childhood: a report from the French Leukaemia Long-Term Follow-Up Study (LEA)

“…[1][2][3][5][6][7] Conditioning regimen chemotherapy and irradiation are often superimposed on the 'standard' therapies, which may compromise pubertal development and final height (FH) in their own right. 8 Also, with the increasing number of survivors and duration of follow-up, patients may experience a significant loss of height potential. The literature contains a number of studies about factors that adversely affect growth in children treated for AL (age at the time of AL treatment, irradiation dose and fraction size, and so on).…”