Growth and development of long-term survivors of childhood acute lymphoblastic leukemia treated with and without prophylactic radiation of the central nervous system.

Two groups of patients with at least four years of remission following treatment of acute lymphoblastic leukemia with or without prophylactic cranial irradiation (mean interval of 8 years from diagnosis) were studied. Out of 41 eligible patients, 22 patients were assessed for pubertal staging, growth velocity, cranial computed tomography scanning, and complete endocrinologic status following stimulation with arginine or insulin hypoglycemia, TRH and LHRH. Group I (N = 9, 4 male, 5 female) had received systemic chemotherapy and intratheral methotrexate, but no cranial irradiation. Group II (N = 13, 9 male: 4 female) had additionally received central nervous system irradiation (2400 rads). All patients had undergone normal spontaneous puberty, and had normal levels of thyroxine, thyrotropin, dihydroepiandrosterone sulfate, testosterone or estrogens, luteinizing hormone, follicle stimulating hormone, prolactin, and cortisol. In Group I only one patient decreased his percentile height greater than 25% but he had normal growth hormone responses. In Group II, two younger patients showed growth deceleration with inadequate provocative growth hormone responses, whereas two pubertal patients developed growth arrest post diagnosis and treatment but had normal growth hormone responses. When Groups I and II and controls were compared as to the number of growth hormone samples greater than 5 ng/ml, the peak growth hormone value, or the mean growth hormone concentration during the combined arginine-insulin test, no significant differences were noted. Brain scan abnormalities were noted in 3 out of 9 patients in Group I (33%) and in 5 out of 11 patients in Group II (45%). There was no correlation in either group between abnormal computed tomography scans and abnormal growth hormone secretory dynamics.(ABSTRACT TRUNCATED AT 250 WORDS)