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Height deficit during and many years after treatment for acute lymphoblastic leukemia in children: A review



There are conflicting data on the incidence and severity of height deficits in children with acute lymphoblastic leukemia (ALL). This is probably due to: (1) collection of data in different phases of treatment; (2) differences in chemotherapeutic regimens; (3) inclusion or not of children who had received cranial irradiation (CRT); (4) limited numbers of patients; (5) relative numbers of prepubertal and pubertal children; (6) different ways of measuring growth deficits. Twenty-five papers published between 1987 and 2006 were reviewed. These reveal that (1) chemotherapy always causes some height reduction during treatment regardless of whether additional CRT is given; (2) catch-up growth occurs immediately after cessation of treatment; (3) intensive chemotherapy alone significantly decreases height in the long-term but to a lesser extent than with additional CRT; (4) young children develop more severe height loss; (5) girls are reported to have greater height deficits but confounding factors have not been adequately considered; (6) late growth hormone (GH) deficiency has been detected in many children, mostly in those who had CRT; (7) GH replacement therapy seems to be effective. ALL relapse in GH-treated children is not more common than in those not treated with GH. Pediatr Blood Cancer 2008;50:509–516. © 2007 Wiley-Liss, Inc.