Decreased adult height in survivors of childhood acute lymphoblastic leukemia: a report from the Childhood Cancer Survivor Study.
OBJECTIVE
To determine risk factors associated with reduced adult height in survivors of childhood acute lymphoblastic leukemia (ALL).


METHODS
This was a cross-sectional study. Attained adult height was determined among 2434 ALL survivors participating in the Childhood Cancer Survivor Study, a cohort of 5-year survivors of common pediatric cancers diagnosed from 1970 to 1986, and compared with 3009 siblings.


RESULTS
All survivor treatment exposure groups (chemotherapy alone, chemotherapy with cranial or craniospinal radiotherapy) had decreased adult height and an increased risk of adult short stature (height standard deviation score < -2) compared with siblings (P < .001). Compared with siblings, the risk of short stature for survivors treated with chemotherapy alone was elevated (OR, 3.4; 95% CI, 1.9, 6.0). Among survivors, significant risk factors for short stature included diagnosis of ALL before puberty, higher-dose cranial radiotherapy (> or = 20 Gy versus < 20 Gy), any radiotherapy to the spine, and female sex.


CONCLUSIONS
Survivors of childhood ALL are at increased risk of adult short stature, including those treated with chemotherapy alone. Risk is highest for those treated with cranial and craniospinal radiotherapy at a young age.
Chow
Eric J
EJ
Department of Pediatrics, University of Washington, Seattle, Washington, USA. ericchow@u.washington.edu
Friedman
Debra L
DL
Yasui
Yutaka
Y
Whitton
John A
JA
Stovall
Marilyn
M
Robison
Leslie L
LL
Sklar
Charles A
CA
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D017668:Age of Onset; D000970:Antineoplastic Agents / Q000627:therapeutic use; D001827:Body Height; D002170:Canada / Q000453:epidemiology; D002648:Child; D002657:Child Development; D002675:Child, Preschool; D015331:Cohort Studies; D003131:Combined Modality Therapy / Q000706:statistics & numerical data; D003430:Cross-Sectional Studies; D004305:Dose-Response Relationship, Drug; D004307:Dose-Response Relationship, Radiation; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000453:epidemiology* / Q000628:therapy*; D011627:Puberty; D011878:Radiotherapy / Q000706:statistics & numerical data; D012307:Risk Factors; D012737:Sex Factors; D035781:Siblings; D017741:Survivors / Q000706:statistics & numerical data*; D014481:United States / Q000453:epidemiology
D000970:Antineoplastic Agents