Growth and pubertal patterns in young survivors of childhood acute lymphoblastic leukemia

Background: Survivors of acute lymphoblastic leukemia (ALL) may experience endocrine dysfunction. This study evaluated growth and pubertal patterns in survivors of childhood ALL. Methods: Longitudinal assessment of anthropometric measurements and pubertal status was performed in a retrospective cohort of survivors (n = 183). Median age at last endocrine visit was 16.1 years (range 8.2-27.6); median follow-up time was 8.7 years (range 3-21.4). Results: Treatment with chemotherapy + prophylactic cranial radiation (pCRT, n = 29) was associated with lower mean height standard deviation score (SDS) than chemotherapy alone (n = 154) (p = 0.001) and higher prevalence of adult short stature (13% vs. 2.2%). Mean age at pubertal onset was normal (girls: 10.3 +/- 1.3 years; boys: 12.0 +/- 1.3 years). Precocious puberty, diagnosed in 8.7% of patients, was more prevalent in pCRT-treated girls. Rates of overweight and obesity were 22.9% and 9.3%, respectively. Predictors of endocrine disorders were pCRT (p = 0.031) and female gender (p = 0.041); of obesity, higher body mass index (BMI)-SDS at diagnosis (p = 0.001); and of short stature, lower height-SDS at diagnosis (p = 0.038). Conclusions: Most childhood ALL survivors given chemotherapy alone attain normal adult height and puberty. Childhood ALL survivors are at increased risk of overweight, especially those with increased BMI at diagnosis. Clinicians should screen for overweight early in survivorship and introduce early interventions.