Pubertal growth in young adult survivors of childhood leukemia.
OBJECTIVE
To determine the effect of cranial irradiation (18 Gy and 24 Gy) on pubertal growth in young adult survivors of childhood acute lymphoblastic leukemia (ALL).


METHODS
Final height (FH) and pubertal growth were retrospectively examined in 142 young adult survivors of childhood ALL. All were in first remission and had received either 18 or 24 Gy of cranial irradiation. Eighty-four children (48 girls) were treated with 24 Gy and 58 (35 girls) with 18 Gy. None had received either testicular or spinal irradiation. Timing and duration of puberty were studied in 110 patients.


RESULTS
Significant reduction in height standard deviation score (SDS) from diagnosis to FH was seen in both sexes and in both dose groups. In girls, in both dose groups, mean age at peak height velocity (PHV) and mean age at menarche occurred significantly earlier than in the normal population. In boys, there was a normal timing of PHV. The amplitude of PHV was significantly reduced in both sexes and in both dose groups. Parameters of pubertal duration (PHV to menarche, PHV to FH, and menarche to FH) were not significantly different from normal population values.


CONCLUSIONS
In conclusion, puberty occurred early in girls, but not in boys. Amplitude of PHV was reduced in both sexes, with no reduction in the duration of puberty. It is likely that disturbances of both timing and quality of growth during puberty contribute to the loss of standing height and body disproportion seen in these children.
Didcock
E
E
Department of Child Health, Queens Medical Centre, Nottingham, United Kingdom.
Davies
H A
HA
Didi
M
M
Ogilvy Stuart
A L
AL
Wales
J K
JK
Shalet
S M
SM
D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001215:Asparaginase / Q000627:therapeutic use; D001827:Body Height / Q000528:radiation effects; D001932:Brain Neoplasms / Q000517:prevention & control*; D002648:Child; D003131:Combined Modality Therapy; D016371:Cranial Irradiation / Q000009:adverse effects*; D003630:Daunorubicin / Q000627:therapeutic use; D005260:Female; D005500:Follow-Up Studies; D006128:Growth / Q000528:radiation effects*; D006801:Humans; D008297:Male; D008572:Menarche / Q000528:radiation effects; D008727:Methotrexate / Q000627:therapeutic use; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000188:drug therapy / Q000503:physiopathology / Q000532:radiotherapy*; D011239:Prednisolone / Q000627:therapeutic use; D011627:Puberty / Q000528:radiation effects*; D011878:Radiotherapy / Q000009:adverse effects; D012189:Retrospective Studies; D012737:Sex Factors; D014750:Vincristine / Q000627:therapeutic use
D014750:Vincristine; D011239:Prednisolone; D001215:Asparaginase; D008727:Methotrexate; D003630:Daunorubicin