Decreased adult height in survivors of childhood acute lymphoblastic leukemia: a report from the Childhood Cancer Survivor Study

J Pediatr. 2007 Apr;150(4):370-5, 375.e1. doi: 10.1016/j.jpeds.2006.11.036.


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 (> or = 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.

Publication types

  • Comparative Study
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Age Factors
  • Age of Onset
  • Antineoplastic Agents / therapeutic use
  • Body Height*
  • Canada / epidemiology
  • Child
  • Child Development
  • Child, Preschool
  • Cohort Studies
  • Combined Modality Therapy / statistics & numerical data
  • Cross-Sectional Studies
  • Dose-Response Relationship, Drug
  • Dose-Response Relationship, Radiation
  • Female
  • Humans
  • Infant
  • Infant, Newborn
  • Male
  • Middle Aged
  • Precursor Cell Lymphoblastic Leukemia-Lymphoma / epidemiology*
  • Precursor Cell Lymphoblastic Leukemia-Lymphoma / therapy*
  • Puberty
  • Radiotherapy / statistics & numerical data
  • Risk Factors
  • Sex Factors
  • Siblings
  • Survivors / statistics & numerical data*
  • United States / epidemiology


  • Antineoplastic Agents