Research Article

Timing of menarche among survivors of childhood acute lymphoblastic leukemia: A report from the Childhood Cancer Survivor Study

  1. Eric J. Chow MD, MPH1,2,*,
  2. Debra L. Friedman MD, MS1,2,
  3. Yutaka Yasui PhD3,
  4. John A. Whitton MS2,
  5. Marilyn Stovall PhD4,
  6. Leslie L. Robison PhD5,
  7. Charles A. Sklar MD6

Article first published online: 29 AUG 2007

DOI: 10.1002/pbc.21316

Issue

Pediatric Blood & Cancer

Pediatric Blood & Cancer

Volume 50, Issue 4, pages 854–858, April 2008

Additional Information

How to Cite

Chow, E. J., Friedman, D. L., Yasui, Y., Whitton, J. A., Stovall, M., Robison, L. L. and Sklar, C. A. (2008), Timing of menarche among survivors of childhood acute lymphoblastic leukemia: A report from the Childhood Cancer Survivor Study. Pediatric Blood & Cancer, 50: 854–858. doi: 10.1002/pbc.21316

Author Information

  1. 1

    Department of Pediatrics, University of Washington, Seattle, Washington

  2. 2

    Fred Hutchinson Cancer Research Center, Seattle, Washington

  3. 3

    Department of Public Health Sciences, University of Alberta, Edmonton, Alberta, Canada

  4. 4

    Department of Radiation Physics, University of Texas, M.D. Anderson Cancer Center, Houston, Texas

  5. 5

    Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee

  6. 6

    Department of Pediatrics, Memorial Sloan-Kettering Cancer Center, New York, New York

*Fred Hutchinson Cancer Research Center, P.O. Box 19024, Mailstop M4-C308, Seattle, WA 98109-1024.

Publication History

  1. Issue published online: 19 FEB 2008
  2. Article first published online: 29 AUG 2007
  3. Manuscript Accepted: 21 JUN 2007
  4. Manuscript Received: 4 MAR 2007

Funded by

  • National Institutes of Health. Grant Number: U24-CA55727
  • National Cancer Institute, Pediatric Oncology Research Training Program. Grant Number: T32-CA009351

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Keywords:

  • alkylating agents;
  • late effects;
  • leukemia;
  • menarche;
  • puberty;
  • radiation

Abstract

Background

The objective of this study was to determine risk factors associated with abnormal timing of menarche among survivors of childhood acute lymphoblastic leukemia (ALL).

Procedure

Self-reported age of menarche was determined among 949 female ALL survivors participating in the Childhood Cancer Survivor Study (CCSS), a cohort of 5-year survivors of common pediatric cancers diagnosed from 1970 to 1986, and compared with 1,128 siblings.

Results

The majority of survivors (92%) and siblings (97%) reported menarche between the ages of 10 and 16. Survivors treated with chemotherapy alone, including those exposed to alkylating agents, experienced menarche at a similar rate to siblings. However, compared to chemotherapy alone, cranial radiotherapy was associated with early menarche (age < 10; OR 6.2, 95% CI 2.1, 18.5) while craniospinal radiotherapy was associated with both early (OR 8.6, 95% CI 1.9, 38.6) and late (age > 16; OR 4.8, 95% CI 1.4, 16.7) menarche. There were no differences in effect between <20 and ≥20 Gy radiotherapy doses. In multivariable analysis, younger age at diagnosis was an independent risk factor for early menarche.

Conclusions

Few female childhood ALL survivors experienced menarche outside of the normal range. Alkylating agent exposure was not associated with abnormal timing. However, those exposed to cranial and craniospinal radiotherapy, especially at a young age, should be monitored closely for abnormal timing of menarche. Pediatr Blood Cancer 2008;50:854–858. © 2007 Wiley-Liss, Inc.

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