BFM-type chemotherapy for childhood acute lymphoblastic leukemia impairs pubertal spurt and causes moderate adult height loss

Objectives. To assess the pattern of somatic development in subjects who recovered from childhood acute lymphoblastic leukemia and to define the role of cranial irradiation and intensive chemotherapy. Methods. We investigated 85 patients, 46 girls (mean age at diagnosis 6.3 years, at last follow-up 13.8 years) and 39 boys (mean age at diagnosis 7.8 years, at last follow-up 15.5 years) treated in the AIEOP-ALL-88 study with BFM-type, intensive chemotherapy; high-risk patients (n = 30) received cranial irradiation as well. Growth profiles (height, weight, growth velocity, BMI) were characterized. Results. Height-standard deviation score (SDS) from target height at diagnosis was +0.64 (girls) and +0.60 (boys), which turned into +0.24 and +0.22 after a mean follow-up of 7.5 and 7.7 years. Thus, there was a mild decrease in height-SDS by -0.39 ± 0.08 (mean ± SE) in both groups. Weight-SDS increased by 0.33 ± 0.17 (girls) and 0.63 ± 0.22 (boys), particularly in patients aged below 7 years. Height growth did not depend on age at treatment. Velocity curves widely differed between ALL and controls, mainly in pubertal spurt from take-off to peak velocity. Conclusions. Subjects who recovered from childhood all with BFM-type chemotherapy are prone to moderate height loss - more evident in females, and to overweight - especially in irradiated males.