Growth and Final Height After Treatment for Childhood Hodgkin Disease

Abstract

Purpose: To evaluate in children the impact of contemporary treatment for Hodgkin disease on the pattern of growth and final height.

Patients and Methods: We studied 80 patients (54 males) aged <14 years at diagnosis, with newly diagnosed, pathologically confirmed Hodgkin disease, treated at a single institution. Forty-six patients received chemotherapy (CT) + radiotherapy (RT), 23 patients received RT alone, and 11 patients received CT alone. Heights were obtained at diagnosis, at the end of treatment, 1, 2, and 3 years after the end of treatment and at attainment of final height. Heights were converted to age- and sex-adjusted SD scores (SDS).

Results: There was a significant change in height SDS at the end of treatment compared to height SDS at diagnosis for all three groups (CT + RT: −0.33, p < 0.001; RT: +0.09, p = 0.027; CT: −0.24, p = 0.012). Over the 3 years following treatment, the rate of change of height SDS was not statistically different between the three treatment groups. Final height SDS was decreased for patients receiving RT + CT (-0.41 SDS, p = 0.02; n = 31). The change in final height SDS for patients receiving RT or CT only was −0.36 (n = 14) and +0.42 (n = 4), respectively. Loss of final height SDS correlated with younger age at diagnosis (p = 0.005). Patients receiving higher RT doses tended to fare worse (p = 0.08).

Conclusions: Pediatric patients treated for Hodgkin disease with the combination of RT and CT suffer a small but significant decrease in their final height SDS. Younger patients and those treated with higher RT doses appear to experience the greatest loss of height potential.