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Growth in Children Treated for Acute Lymphoblastic Leukemia: Single Institution Report from North India

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Indian Journal of Hematology and Blood Transfusion Aims and scope Submit manuscript

Abstract

Survivors of childhood leukemia are at risk of impaired growth and short stature as adults due to intensive combination chemotherapy and radiation injury. This study was undertaken to evaluate anthropometry in children treated for acute lymphoblastic leukemia (ALL). Children treated for ALL and off treatment for a minimum period of 2 years were evaluated for height, weight and BMI. Z scores were calculated for height, weight and BMI: at induction, 6 months after starting treatment, at end of treatment and at 2 years after completion of therapy. Change in z scores were calculated and compared with CDC criteria and Agarwal standards for Indian children. Fifty two boys and 21 girls were analyzed. Height and weight z scores were seen to show a steep decrease during the initial intensive phase of therapy. The gain in height and weight continued to be slow during therapy and catch up occurred after cessation of therapy. On completion of therapy, patients were shorter, but not significantly so. Girls <9 years were significantly shorter. Weight remained on the lower side of normal. Change of z scores was statistically significant for weight at end of treatment (p = 0.032) and 2 years after completion of treatment (p = 0.00). BMI z score increased throughout the study period. Peak growth velocities were also late in the study subjects Anthropometric variables of height, weight and BMI are affected by ALL during therapy. Growth deceleration is maximum during the intensive phase of therapy. Catch up growth occurs but children remain smaller than their peers.

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References

  1. Viana MB, Vilela VI (2008) Height deficit during and many years after treatment for acute lymphoblastic leukemia in children: a review. Pediatr Blood Cancer 50(2 suppl):509–516

    Article  PubMed  Google Scholar 

  2. Argüelles Barrios V, Pozo J, Muñoz MT, Argente J (2000) Modifications of growth velocity and the insulin-like growth factor system in children with acute lymphoblastic leukemia: a longitudinal study. J Clin Endocrinol Metab 85(11):4087–4092

    PubMed  Google Scholar 

  3. Birkebaek NH, Clausen N (1998) Height and weight pattern up to 20 years after treatment for acute lymphoblastic leukemia. Arch Dis Child 79:161–164

    Article  CAS  PubMed  Google Scholar 

  4. Ahmed SF, Wallace WH, Kelnar CJ (1997) An anthropometric study of children during intensive chemotherapy for acute lymphoblastic leukemia. Horm Res 48:178–188

    Article  CAS  PubMed  Google Scholar 

  5. Manteiro IM, Bedone AJ, Pinto CL, Brandalise SR (1998) Treatment of acute lymphoblastic leukemia and growth. Rev Assoc Med Bras 44(2):77–80

    Google Scholar 

  6. Logghe KA, Bourguignon JP, Craen M, Benoit Y (1988) Factors contributing to the impairment of growth in children with acute lymphoblastic leukemia. Horm Res 30:62–67

    Article  CAS  PubMed  Google Scholar 

  7. Katz JA, Pollock BH, Jacaruso D, Marad A (1993) Final height attained in patients successfully treated for childhood acute lymphoblastic leukemia. J Pediatr 123:546–552

    Article  CAS  PubMed  Google Scholar 

  8. Groot-Loonen JJ, Otten BJ, van’t Hof MA, Lippens RJ, Stoelinga GB (1995) Influence of treatment modalities on prepubertal growth in children with acute lymphoblastic leukemia. Pediatr Hematol Oncol 12(4):343–353

    Article  CAS  PubMed  Google Scholar 

  9. Bhalla AK, Kumar L (2003) Growth attainment of well off Chandigarh children: a mixed longitudinal study. Int J Anthropol 18:113–125

    Article  Google Scholar 

  10. Clayton PE, Shalet SM, Morris Jones PH, Price DA (1988) Growth in children treated for acute lymphoblastic leukemia. Lancet 27:460–462

    Article  Google Scholar 

  11. Hokken-Koelega AC, Van Doorn JW, Hählen K, Stijnen T, de Muinck Keizer-Schrama SM, Drop S (1993) Long-term effects of treatment for acute lymphoblastic leukemia with and without cranial irradiation on growth and puberty: a comparative study. Pediatr Res 33(6):577–582

    Article  CAS  PubMed  Google Scholar 

  12. Sklar C, Mwetens A, Walter A, Mitchell D, Nesbit M, O’Leary M et al (1993) Final height after treatment for childhood acute lymphoblastic leukemia: comparison of no cranial irradiation with 1800 and 2400 centigrays of cranial irradiation. J Pediatr 123:59–64

    Article  CAS  PubMed  Google Scholar 

  13. Jaruratanasirikul S, Owasith K, Wongchanchailert M, Laosombat V, Sriplung H (2004) Growth patterns and final height of survivors of childhood leukemia. J Pediatr Endocrinol Metab 17(5):719–726

    Article  PubMed  Google Scholar 

  14. Holm K, Nysom K, Hertz H, Müller J (1994) Normal final height after treatment for acute lymphoblastic leukemia without irradiation. Acta Paediat 83(12):1287–1290

    Article  CAS  PubMed  Google Scholar 

  15. Cicognani A, Cacciari E, Rosito P, Mancini AF, Carlă G, Mandini M, Paolucci G (1994) Longitudinal growth and final height in long-term survivors of childhood leukaemia. Eur J Pediatr 153(10):726–730

    Article  CAS  PubMed  Google Scholar 

  16. Dalton VK, Rue M, Silverman LB, Gelber RD, Asselin BL, Barr RD, Clavell LA et al (2003) Height and weight in children treated for acute lymphoblastic leukemia : relationship to CNS treatment. J Clin Oncol 21:2953–2960

    Article  PubMed  Google Scholar 

  17. River Luna R, Olaya Vargas A, Frenk S, Leal C, Cardenas Cardos R, Perez Gonzalez O et al (2008) Early death in children with acute lymphoblastic leukemia: does malnutrition play a role. Pediatr Hematol Oncol 25:17–26

    Article  Google Scholar 

  18. National Family Health Survey (NFHS-3) (2005-06) 1:34

  19. Davies HA, Didcock E, Didi M, Ogilvy-Stuart A, Wales JK, Shalet SM (1995) Growth, puberty and obesity after treatment for leukaemia. Acta Paediatr Suppl 411:45–50

    Article  CAS  PubMed  Google Scholar 

  20. Misíková Z, Cap J, Foltinová A (1990) Somatic development after successful therapy of acute lymphoblastic leukemia. Cesk Pediatr 45(11):667–670

    PubMed  Google Scholar 

  21. Krawczuk-Rybak M, Kaliszewski J, Kitszel A (2003) 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. Endokrynol Diabetol Chor Przemiany Materii Wieku Rozw 9(1):41–47

    PubMed  Google Scholar 

  22. Garmey EG, Liu Q, Sklar CA, Meacham LR, Mertens AC, Stovall MA, Yasui Y, Robison LL, Oeffinger KC (2008) Longitudinal changes in obesity and body mass index among adult survivors of childhood acute lymphoblastic leukemia: a report from the Childhood Cancer Survivor Study. J Clin Oncol 26(28):4639–4645

    Article  PubMed Central  PubMed  Google Scholar 

  23. Baillargeon J, Langevin A-M, Lewis M, Grady J, Thomas PJ, Mullins J, Estrada J (2005) Therapy-related changes in body size in Hispanic children with acute lymphoblastic leukemia. Cancer 103(8):1725–1729

    Article  PubMed  Google Scholar 

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The authors state no conflict of interest in this manuscript.

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Authors and Affiliations

  1. Pediatric Hematology Oncology Unit, Postgraduate Institute of Medical Education & Research, Chandigarh, 160012, India

    Amita Trehan, R. K. Marwaha & Deepak Bansal

  2. Department of Pediatrics Advanced Pediatric Centre, Postgraduate Institute of Medical Education & Research, Chandigarh, 160012, India

    Pankaj Kumar & A. K. Bhalla

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  1. Pankaj Kumar
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  2. Amita Trehan
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  3. A. K. Bhalla
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  4. R. K. Marwaha
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  5. Deepak Bansal
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Correspondence to Amita Trehan.

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Kumar, P., Trehan, A., Bhalla, A.K. et al. Growth in Children Treated for Acute Lymphoblastic Leukemia: Single Institution Report from North India. Indian J Hematol Blood Transfus 32, 39–45 (2016). https://doi.org/10.1007/s12288-015-0513-6

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  • DOI: https://doi.org/10.1007/s12288-015-0513-6

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