Cognitive sequelae in children treated for acute lymphoblastic leukemia with dexamethasone or prednisone.
OBJECTIVE
The cognitive sequelae of treatment for childhood acute lymphoblastic leukemia (ALL) were compared in a group of patients who received dexamethasone during the intensification and maintenance phases of therapy with those in a historical control group for whom antileukemia therapy was similar, except that the corticosteroid component of therapy was prednisone.


METHODS
Patients treated for ALL on Dana-Farber Cancer Institute protocols 87-01 (n = 44) and 91-01 (n = 23) were evaluated by standard cognitive and achievement tests. Corticosteroid therapy was delivered in 5-day pulses given every 3 weeks during intensification and continuation phases of therapy for a total of 2 years.


RESULTS
Children treated on protocol 87-01 received prednisone at a dose of 40 mg/m2/d (standard risk, SR) or 120 mg/ m2/d (high risk, HR); those treated on protocol 91-01 received dexamethasone at a dose of 6 mg/m2 per day (SR) or 18 mg/m2 per day (HR). Children treated on protocol 91-01 performed less well on cognitive testing. Subsample analysis indicated that cranial radiation therapy and methotrexate dose did not account for differences in cognitive outcomes.


CONCLUSIONS
The findings of this preliminary study are consistent with the hypothesis that dexamethasone therapy can increase risk for neurocognitive late effects in children treated for ALL and indicate that further investigation of this question is warranted.
Waber
D P
DP
Department of Psychiatry, Children's Hospital, Boston, MA, USA.
Carpentieri
S C
SC
Klar
N
N
Silverman
L B
LB
Schwenn
M
M
Hurwitz
C A
CA
Mullenix
P J
PJ
Tarbell
N J
NJ
Sallan
S E
SE
D018931:Antineoplastic Agents, Hormonal / Q000008:administration & dosage / Q000009:adverse effects*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D001215:Asparaginase / Q000008:administration & dosage; D002648:Child; D003072:Cognition Disorders / Q000139:chemically induced* / Q000209:etiology; D003131:Combined Modality Therapy; D016371:Cranial Irradiation / Q000009:adverse effects; D003561:Cytarabine / Q000008:administration & dosage; D003907:Dexamethasone / Q000008:administration & dosage / Q000009:adverse effects*; D004317:Doxorubicin / Q000008:administration & dosage; D004521:Educational Measurement; D005260:Female; D006801:Humans; D007278:Injections, Spinal; D007859:Learning Disabilities / Q000139:chemically induced / Q000209:etiology; D002955:Leucovorin / Q000008:administration & dosage; D008297:Male; D008569:Memory Disorders / Q000139:chemically induced / Q000209:etiology; D015122:Mercaptopurine / Q000008:administration & dosage; D008727:Methotrexate / Q000008:administration & dosage / Q000009:adverse effects; D009483:Neuropsychological Tests; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000150:complications / Q000188:drug therapy* / Q000523:psychology / Q000532:radiotherapy; D011241:Prednisone / Q000008:administration & dosage / Q000009:adverse effects; D012074:Remission Induction; D013312:Stress, Physiological / Q000378:metabolism / Q000523:psychology; D014750:Vincristine / Q000008:administration & dosage
D018931:Antineoplastic Agents, Hormonal; D003561:Cytarabine; D014750:Vincristine; D003907:Dexamethasone; D004317:Doxorubicin; D015122:Mercaptopurine; D001215:Asparaginase; D002955:Leucovorin; D011241:Prednisone; D008727:Methotrexate