HRQOL implications of treatment with dexamethasone for children with acute lymphoblastic leukemia (ALL).
BACKGROUND
Dexamethasone is increasingly used as the steroid of choice in trials for standard risk children with acute lymphoblastic leukemia (ALL). Improvements in event-free survival (EFS) have been attributed to lower CNS relapse rates, However, there are concerns that dexamethasone may be more toxic than previous conventional therapy with prednisone. Such toxicity raises questions about the implications for child neuropsychological function and HRQOL. Patients participating in the UK ALL 99/01 trial were randomized to receive dexamethasone or prednisone as their steroid in induction and maintenance chemotherapy. We compared the HRQOL and behavior in children randomized to receive both these agents.


METHODS
Standardized questionnaires to assess parent and child HRQOL at 3-6 months after diagnosis (T1) and 1 year later (T2) completed by mothers in family homes. Forty-five mothers of a child with ALL (32 male, 13 female; average age at T1, 7 years 3 months; at T2, 8 years 3 months) completed HRQOL questionnaires.


RESULTS
For the total group, child HRQOL scores improved and behavior problems decreased significantly from T1 to T2. Comparison of HRQOL scores between the 17 children randomized to dexamethasone and 28 children randomized to prednisone showed no significant differences. The rate of improvement in HRQOL from T1 to T2 did not differ between children randomized to dexamethasone or prednisone.


CONCLUSIONS
Dexamethasone is increasingly used in the treatment of ALL and has been linked with improved survival rates. Long-term use of dexamethasone raises questions about neuropsychologic toxicity. Although HRQOL increased significantly over the year for all children, the extent of this increase did not differ by chemotherapy. These results should contribute to lessened concerns about use of dexamethasone in the treatment of ALL.
Eiser
Christine
C
Cancer Research UK Professor of Child Health Psychology, Child and Family Research Group, Department of Psychology, University of Sheffield, Western Bank, Sheffield, United Kingdom. c.eiser@shef.ac.uk
Davies
Helena
H
Jenney
Meriel
M
Stride
Chris
C
Glaser
Adam
A
D000893:Anti-Inflammatory Agents / Q000009:adverse effects* / Q000627:therapeutic use; D002648:Child; D002652:Child Behavior; D002675:Child, Preschool; D003907:Dexamethasone / Q000009:adverse effects* / Q000627:therapeutic use; D005260:Female; D006304:Health Status; D006801:Humans; D008297:Male; D008603:Mental Health; D009035:Mothers / Q000523:psychology; D015337:Multicenter Studies as Topic; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000188:drug therapy*; D011241:Prednisone / Q000009:adverse effects / Q000627:therapeutic use; D011788:Quality of Life; D016032:Randomized Controlled Trials as Topic; D012917:Social Adjustment; D006113:United Kingdom
D000893:Anti-Inflammatory Agents; D003907:Dexamethasone; D011241:Prednisone