Decreased Adult Height in Survivors of Childhood Acute Lymphoblastic Leukemia: A Report from the Childhood Cancer Survivor Study.
Chow, Eric J. MD, MPH; Friedman, Debra L. MD, MS; Yasui, Yutaka PhD; Whitton, John A. MS; Stovall, Marilyn PhD; Robison, Leslie L. PhD; Sklar, Charles A. MD
[Article] Journal of Pediatrics. 150(4):370-375e1, April 2007.

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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 (>=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.

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