Growth patterns in children and adolescents treated for acute lymphoblastic leukaemia

Abstract

Background

Children who have completed treatment for acute lymphoblastic leukaemia (ALL) are known to have impaired growth and nutrition, which in turn leads to chronic cardiometabolic conditions and lower quality of life. This study aimed to assess the prevalence and risk factors for growth impairment and abnormal nutritional status.

Methodology

Children 1–15 years with ALL treated on the Indian Collaborative Childhood Leukaemia group (ICiCLe) protocol were enrolled and retrospectively reviewed. Those who were assessed at all four time points: diagnosis, end of induction, start of maintenance, and end of treatment were included in the study. Nutritional status was defined based on weight-for-age, weight-for-height, and body mass index-for-age as per World Health Organization criteria. Short stature was defined as height-for-age less than 5th percentile.

Results and discussion

This study included 208 children with a median age of 4.9 years out of a cohort of 1750 children. The prevalence of undernutrition, normal nutrition and overnutrition at diagnosis and end of treatment were 37.5 %, 26.9 %, 2.4 % and 5.3 %, 57.2 %, 6.7 % respectively (p < 0.001). The prevalence of short stature increased from 29.5 % at diagnosis till 45 % at end of treatment (p = 0.02). Predictors for developing obesity at end of treatment were over nourished status at start of maintenance (OR 18.869, 95 % CI 5.0–70.99, p < 0.001), high risk ALL (OR 3.077, 95 % CI 0.78–12.09, p = 0.1) and age <5 years at diagnosis (OR 2.185, 95 % CI 0.77–6.15, p = 0.14). Predictors for short stature at end of treatment were height <5th percentile at start of maintenance (OR 14.230, 95 % CI 2.19–92.20, p = 0.005) and height 5-10th percentile at start of maintenance (OR 7.69, 95 % CI 1.72–34.25, p = 0.007).

Conclusion

Children undergoing treatment for acute lymphoblastic leukaemia are at risk for both growth failure, and the development of obesity. Our findings highlight the importance of regular monitoring of height and weight during and after therapy. While we were only able to capture complete data on 12% of eligible patients for a variety of reasons, we feel that all children on treatment for ALL should be strongly encouraged to adopt a healthy and nutritious diet and incorporate physical activity in their daily routine.