[The influence of age, gender and modifications of therapeutic protocols on physical development of children and adolescents after completion of therapy for acute lymphoblastic leukemia].
THE AIM of the study was the longitudinal assessment of physical development of children treated for acute lymphoblastic leukemia (ALL) in the past. A total group of 76 children (51 girls), from whom 63 get ill before puberty, were included in the study. Therapy was managed according to BFM protocols in which central nervous system (CNS) prophylaxis was used in 27 children in dose 12 Gy, methotrexate in dose 5 g/m(2) was used in 63 children and 1g/m(2) in 13 children. Height and body mass index expressed as standard deviation score (SDS) in the time of diagnosis (H1 SDS, BMI1 SDS), after intensive therapy (H2 SDS, BMI2 SDS) and after 1.7+/-3.13 years from therapy (H3 SDS, BMI3 SDS) were assessed.


RESULTS
1. BMI2 SDS values increased in relation to BMI1 SDS (p=0.0000001) and BMI3 SDS values insignificantly decreased, but they were higher than at the time of diagnosis. 2. We affirmed increase of BMI2 SDS in the group of boys directly after the treatment (p=0.00006) and later decrease (p=0.04), so there were no differences between BMI1 SDS and BMI3 SDS. 3. The increase of BMI2 SDS in comparison with BMI1 SDS (p=0.007) was kept until the treatment completed in the group of girls (p=0.05 between BMI1 SDS and BMI3 SDS). 4. The increase and next decrease of BMI SDS values was observed among children who get ill before puberty. But we noticed intermittent increase of BMI SDS in the puberty children at the time of diagnosis. 5. We affirmed increase of BMI SDS after the treatment completed in the group of children treated with only cytostatics. The increase of BMI SDS (p=0.02) and next decrease of BMI3 SDS (p=0.007) was noticed in the group with CNS prophylaxis, there were no differences between BMI1 SDS and BMI3 SDS. 6. We observed increase of BMI2 SDS and BMI3 SDS in comparison with BMI1 SDS (p=0.00001 and p=0.0004) in the group treated with 5 g/m(2) methotrexate. BMI3 SDS values were decreased in comparison with BMI2 SDS (p=0.01) and BMI1 SDS (p=0.006) in the group treated with 1 g/m(2) methotrexate. 7. There were no significant changes in the growth rate during the treatment and after therapy.


CONCLUSIONS
1. ALL treatment contributes to the increase of body mass, which is kept until therapy completed, especially in the group of girls. 2. Growth rate including children with CNS prophylaxis does not submit significantly disturbances.
Krawczuk-Rybak
Maryna
M
Klinika Onkologii Dzieciecej Samodzielnego Publicznego Dzieciecego Szpitala Klinicznego AM w Białymstoku, Białystok, Poland.
Kaliszewski
Jacek
J
Kitszel
Anna
A
D000367:Age Factors; D000971:Antineoplastic Combined Chemotherapy Protocols; D001215:Asparaginase / Q000008:administration & dosage; D015992:Body Mass Index; D002648:Child; D003520:Cyclophosphamide / Q000008:administration & dosage; D003561:Cytarabine / Q000008:administration & dosage; D003630:Daunorubicin / Q000008:administration & dosage; D004317:Doxorubicin / Q000008:administration & dosage; D005260:Female; D006128:Growth; D006801:Humans; D008137:Longitudinal Studies; D015122:Mercaptopurine / Q000008:administration & dosage; D008727:Methotrexate / Q000008:administration & dosage; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000503:physiopathology* / Q000628:therapy*; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors; D013866:Thioguanine / Q000008:administration & dosage; D014750:Vincristine / Q000008:administration & dosage
D003561:Cytarabine; D014750:Vincristine; D004317:Doxorubicin; D003520:Cyclophosphamide; D015122:Mercaptopurine; D001215:Asparaginase; D013866:Thioguanine; D008727:Methotrexate; D003630:Daunorubicin