Adult survivors of childhood acute lymphoblastic leukaemia with GH deficiency have normal self-rated quality of life but impaired neuropsychological performance 20 years after cranial irradiation.
OBJECTIVE
Cranial radiotherapy (CRT) was, until recently, important for achieving long-term survival in acute lymphoblastic leukaemia (ALL). Because survival rates have improved markedly, the long-term complications, such as GH deficiency (GHD) and neuropsychological impairment, have become increasingly important.


METHODS
The level of self-reported quality of life and neuropsychological functioning was investigated in 44 adults (21 women) with a median age of 25 years who had been treated for childhood onset (CO) ALL with CRT (median 24 Gy). Comparison was made with matched population controls. A subset of patients with GHD was evaluated for neuropsychological functioning after 1 year of GH treatment.


RESULTS
Compared to controls, the patients had significantly lower performance in neuropsychological tests. Early age at treatment had a significant negative impact on neuropsychological performance in adulthood. No relationship was found between dose of CRT, time since treatment of ALL or gender and neuropsychological performance. Compared to controls, the patients did not show a poor quality of life or a lowered availability of social interactions or social networks; however, significantly more patients were living alone or with their parents. After GH testing, the patients were all considered GH deficient or insufficient, but no relationship was observed between stimulated peak GH secretion and neuropsychological performance. Treatment with GH for 1 year in a subgroup of the patients did not improve their neuropsychological performance.


CONCLUSIONS
This study showed that adults treated with CRT for CO ALL had GHD and significantly impaired neuropsychological performance, although self-reported quality of life was not affected. The effect of GH treatment in this patient group has to be further elucidated.
Link
Katarina
K
Department of Endocrinology, Lund University Hospital, Lund, Sweden.
Moëll
Christian
C
Osterberg
Kai
K
Persson
Roger
R
Ørbaek
Palle
P
Garwicz
Stanislaw
S
Cavallin-Ståhl
Eva
E
Erfurth
Eva Marie
EM
D000328:Adult; D016022:Case-Control Studies; D016371:Cranial Irradiation / Q000009:adverse effects*; D004522:Educational Status; D005260:Female; D005500:Follow-Up Studies; D013006:Growth Hormone / Q000172:deficiency*; D006801:Humans; D007334:Insulin-Like Growth Factor I / Q000032:analysis; D008297:Male; D008393:Marriage; D009483:Neuropsychological Tests; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000097:blood / Q000523:psychology* / Q000532:radiotherapy*; D011788:Quality of Life; D012923:Social Class; D012931:Social Environment; D018709:Statistics, Nonparametric; D017741:Survivors / Q000523:psychology*
D007334:Insulin-Like Growth Factor I; D013006:Growth Hormone