Abstract
Several recent reports have indicated, that early puberty and impaired pubertal growth occur in patients treated for ALL. Rarely a long-term longitudinal follow-up has been reported including the adolescent growth-spurt, the AH and TH of patients treated with the same protocol.
50 patients are in 1st CCR after treatment for ALL with the BFM-70 and BFM-76-protocol. Puberty, pubertal growth and AH were evaluated, when peak height velocity (PHV) did not occur within the 1 st year after therapy.
All patients received intensive induction chemotherapy and prophylactic cranial irradiation with 18 or 24 Gy. Maintenance chemotherapy consisted of daily purinethoi and weekly methotrexate (BMF-76) or weekly methotrexate and cyclophosphamide (BFM-70) as well as three two week courses of prednisone and vincristine during the first year of therapy. The total duration of therapy was 2 1/2 (BFM-70) or 2 vs. 2 1/2 years (BFM 76).
Pubertal growth was documented at different time intervals during puberty including peak height velocity. PHV was 8.8 ± 2.1 cm in girls and 9.1 ± 0.5 cm in boys, comparing favourably with normal standards of 9.8 ± 1.2 cm in boys and 8.1 ± 1.2 cm in girls (Buckler, 1990). Normal growth was also noted for other pubertal periods i.e. menarche to AH, PHV to AH etc., On the other hand the age of PHV was early in girls 10.7 ± 1.4 years vs 12.2 ± 1.0 years (controls) and normal in boys (13.6 ± 10.3 vs 13.9 ± 0.8 years). While growth was normal during puberty the mean height-SDS before, after therapy and AH indicated a continuous loss of height-SDS with 0.74, 0.23 and 0.18 SDS for the total group of boys and girls. In contrast, normal adult height was reached with 179.7 ± 6.4 cm (boys) and 163.5 ± 6.1 cm (girls) which was not different from TH (Tanner method) of 177.5 ± 4.5 cm and 163.2 ± 3.1 cm.
We conclude, that height-SDS for CA is a poor predictor of growth and AH, because it indicates a continuous loss of height potential. Since AH is normal and not different from TH, no major loss of height is present. Thus, TH is the most appropriate method in evaluating growth and estimating AH in patients treated for ALL.
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Bramswig, J., Zielinski, G., Schellong, G. et al. PUBERTAL GROWTH, ADULT HEIGHT (AH) AND TARGET HEIGHT (TH) IN 50 PATIENTS TREATED FOR ACUTE LYMPHOBLASTIC LEUKEMIA (ALL) -A LONGITUDINAL STUDY. Pediatr Res 33 (Suppl 5), S61 (1993). https://doi.org/10.1203/00006450-199305001-00346
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DOI: https://doi.org/10.1203/00006450-199305001-00346