Young adult survivors of childhood acute lymphoblastic leukemia: spontaneous GH secretion in relation to CNS radiation

2.50
Hdl Handle:
http://hdl.handle.net/2336/64233
Title:
Young adult survivors of childhood acute lymphoblastic leukemia: spontaneous GH secretion in relation to CNS radiation
Authors:
Jarfelt, M; Bjarnason, R; Lannering, B
Citation:
Pediatr Blood Cancer. 2004, 42(7):582-8
Issue Date:
1-Jun-2004
Abstract:
BACKGROUND: Young adults who are long-term survivors of acute lymphoblastic leukaemia (ALL) in early childhood usually do well and do not have to go to regular medical checkups. Many of these survivors did receive prophylactic cranial radiotherapy during their oncological treatment. The effect of cranial irradiation on the hypothalamus is considered to be progressive. Therefore, late effects, such as reduced growth hormone (GH) secretion, may remain undetected until adulthood. PROCEDURE: Records from all patients treated for ALL before the onset of puberty in the region of West Sweden, between 1 January 1973 and 31 December 1985 were included, provided they were in first remission with a minimum follow-up time of 15 years, and a minimum age of 20. These criteria were met by 47 young adults aged 20-32 years, of whom 35 agreed to participate. We studied spontaneous GH secretion over 24 hr, IGF-I and IGFBP-3, final height and BMI. The patients had been treated according to three consecutive Swedish childhood leukaemia group protocols. The median follow-up time was 20 years, and 19 of the patients had been treated with cranial irradiation (CRT+), 16 had not (CRT-). RESULTS: CRT+ patients had significantly lower maximal peaks of GH than CRT- patients. Fifty percent of the CRT+ patients had a GH(max) below the cut-off level (3.3 microg/l), for GH treatment. CRT- patients all had GH(max) levels considered within the normal range. Final height of all the patients, except one CRT+ women, was in the range of expected midparental height, the median loss in final height in the CRT+ patients was 0.8 standard deviation (SD). No patient in this study was obese by definition (BMI <30 kg/m(2)). IGF-I and IGFBP-3 concentrations did not correlate to variations in spontaneous GH secretion in these patients. CONCLUSIONS: In spite of the little effect on final height, we found impaired spontaneous GH secretion in 79% of young adults 20-32 years of age, and GH deficiency (GHD) in 47% after low-dose cranial irradiation in early childhood. The consequences of this low-GH secretion need to be investigated.
Description:
To access publisher full text version of this article. Please click on the hyperlink in Additional Links field
Additional Links:
http://dx.doi.org/10.1002/pbc.20020

Full metadata record

DC FieldValue Language
dc.contributor.authorJarfelt, M-
dc.contributor.authorBjarnason, R-
dc.contributor.authorLannering, B-
dc.date.accessioned2009-04-03T12:00:48Z-
dc.date.available2009-04-03T12:00:48Z-
dc.date.issued2004-06-01-
dc.date.submitted2009-04-03-
dc.identifier.citationPediatr Blood Cancer. 2004, 42(7):582-8en
dc.identifier.issn1545-5009-
dc.identifier.pmid15127412-
dc.identifier.doi10.1002/pbc.20020-
dc.identifier.urihttp://hdl.handle.net/2336/64233-
dc.descriptionTo access publisher full text version of this article. Please click on the hyperlink in Additional Links fielden
dc.description.abstractBACKGROUND: Young adults who are long-term survivors of acute lymphoblastic leukaemia (ALL) in early childhood usually do well and do not have to go to regular medical checkups. Many of these survivors did receive prophylactic cranial radiotherapy during their oncological treatment. The effect of cranial irradiation on the hypothalamus is considered to be progressive. Therefore, late effects, such as reduced growth hormone (GH) secretion, may remain undetected until adulthood. PROCEDURE: Records from all patients treated for ALL before the onset of puberty in the region of West Sweden, between 1 January 1973 and 31 December 1985 were included, provided they were in first remission with a minimum follow-up time of 15 years, and a minimum age of 20. These criteria were met by 47 young adults aged 20-32 years, of whom 35 agreed to participate. We studied spontaneous GH secretion over 24 hr, IGF-I and IGFBP-3, final height and BMI. The patients had been treated according to three consecutive Swedish childhood leukaemia group protocols. The median follow-up time was 20 years, and 19 of the patients had been treated with cranial irradiation (CRT+), 16 had not (CRT-). RESULTS: CRT+ patients had significantly lower maximal peaks of GH than CRT- patients. Fifty percent of the CRT+ patients had a GH(max) below the cut-off level (3.3 microg/l), for GH treatment. CRT- patients all had GH(max) levels considered within the normal range. Final height of all the patients, except one CRT+ women, was in the range of expected midparental height, the median loss in final height in the CRT+ patients was 0.8 standard deviation (SD). No patient in this study was obese by definition (BMI <30 kg/m(2)). IGF-I and IGFBP-3 concentrations did not correlate to variations in spontaneous GH secretion in these patients. CONCLUSIONS: In spite of the little effect on final height, we found impaired spontaneous GH secretion in 79% of young adults 20-32 years of age, and GH deficiency (GHD) in 47% after low-dose cranial irradiation in early childhood. The consequences of this low-GH secretion need to be investigated.en
dc.language.isoenen
dc.publisherJohn Wileyen
dc.relation.urlhttp://dx.doi.org/10.1002/pbc.20020en
dc.subject.meshAdulten
dc.subject.meshBody Heighten
dc.subject.meshBrainen
dc.subject.meshFemaleen
dc.subject.meshFollow-Up Studiesen
dc.subject.meshGrowth Hormoneen
dc.subject.meshHumansen
dc.subject.meshInsulin-Like Growth Factor Ien
dc.subject.meshMaleen
dc.subject.meshPrecursor Cell Lymphoblastic Leukemia-Lymphomaen
dc.titleYoung adult survivors of childhood acute lymphoblastic leukemia: spontaneous GH secretion in relation to CNS radiationen
dc.typeArticleen
dc.contributor.departmentDepartment of Pediatrics, Division of Hematology and Oncology, Sahlgrenska Academy of Göteborg University, Göteborg, Sweden. marianne.jarfelt@vgregion.seen
dc.identifier.journalPediatric blood & canceren

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