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Menarche in a cohort of 188 long-term survivors of acute lymphoblastic leukemia

Authors
Journal
The Journal of Pediatrics
0022-3476
Publisher
Elsevier
Publication Date
Volume
131
Issue
4
Identifiers
DOI: 10.1016/s0022-3476(97)70069-6
Disciplines
  • Design
  • Medicine

Abstract

Abstract Objective: As more children survive acute lymphoblastic leukemia (ALL), questions are raised regarding how the disease and its therapy affect their pubertal development. Study design: The National Institute of Child Health and Human Development–National Cancer Institute–Children’s Cancer Group Leukemia Follow-Up Study used a historical cohort design to investigate menarche in 188 ALL survivors who were premenarchal at diagnosis, aged at least 18 years, at least 2 years after diagnosis, alive, and in remission. Female siblings of ALL survivors ( n = 218) served as control subjects. Results: Menarche occurred within the normal age range in 92% of survivors and 96% of the control subjects ( p = 0.09). Early menarche occurred in four survivors (2%) and three control subjects (1%). Delayed, absent, or medically induced menarche was reported by 12 survivors (6%) and six control subjects (3%). Compared with the control subjects, survivors of ALL who received 1800 cGy cranial radiation before the age of 8 years had significantly earlier menarche, relative hazard (RH) of 2.2 (95% confidence interval: 1.4, 3.4 [ p = 0.0003]). Survivors receiving 2400 cGy of craniospinal radiation with or without abdominal radiation had significantly later menarche than the control subjects, RH 0.4 (95% confidence interval: 0.3, 0.7 [ p = 0.0002]). Conclusions: In this large cohort of ALL survivors, the risk of disordered menarche was low. However, younger subjects receiving 1800 cGy cranial radiation and those receiving 2400 cGy below the diaphragm required careful monitoring. (J Pediatr 1997; 131:598-602)

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