Decreased adult height in survivors of childhood acute lymphoblastic leukemia: a report from the Childhood Cancer Survivor Study

Abstract

Objective: To determine risk factors associated with reduced adult height in survivors of childhood acute lymphoblastic leukemia (ALL).

Study design: 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.

Figure

Height standard deviation scores (mean + SD) across exposure groups stratified by pubertal status at ALL diagnosis with siblings as comparison. T-test for differences in height SDS between pre- and postpubertal survivors were significant (+, p<0.05; ++, p<0.001). Test of trend across treatment exposure groups (chemotherapy alone, chemotherapy with cranial radiotherapy (CRT), and chemotherapy with craniospinal radiotherapy (CSRT)) was significant for prepubertal survivors (p<0.001), but not postpubertal ones (p=0.37).