title: Dexamethasone in the maintenance phase of acute lymphoblastic leukaemia treatment: is the risk of lethal infections too high?
abstract: We report an increased incidence of infectious deaths during maintenance treatment of the ninth protocol for acute lymphoblastic leukaemia of the Dutch Childhood Oncology Group (DCOG-ALL-9). The main difference in maintenance treatment between DCOG-ALL-9 and the DCOG-ALL-7 and DCOG-ALL-8 protocols is the interruption of methotrexate and 6-mercaptopurine by vincristine (2mg/m(2) weekly) and dexamethasone (6mg/m(2) daily) for 14 days every 7 weeks in the DCOG-ALL-9 protocol. The 1107 children treated with the DCOG-ALL-7, DCOG-ALL-8 or DCOG-ALL-9 protocol were included and screened for infectious death during maintenance treatment (July 1988-July 2002). Seven of the 510 children died of severe infections during the maintenance phase of DCOG-ALL-9, compared to none of the 597 patients during the DCOG-ALL-7 and DCOG-ALL-8 protocols (1.37% versus 0.0%; p=0.013). Results from the current study suggest that repeated, prolonged exposure to dexamethasone results in an increase of lethal infections from 0% to 1.37%. In the dosing-schedule used, the advantage of dexamethasone may not outweigh the higher risk of infectious death.
authors: Department of Paediatrics, Division of Paediatric Oncology/Haematology, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, P.O. Box 30.001, 9700 RB Groningen, The Netherlands.
authors: Esther M
authors: EM
authors: Te Poele
authors: Eveline S J M
authors: ES
authors: de Bont
authors: H
authors: H
authors: Marike Boezen
authors: Tom
authors: T
authors: Revesz
authors: Jos P M
authors: JP
authors: Bökkerink
authors: Auke
authors: A
authors: Beishuizen
authors: Ilse J M
authors: IJ
authors: Nijhuis
authors: Claudi S M
authors: CS
authors: Oude Nijhuis
authors: Anjo J P
authors: AJ
authors: Veerman
authors: Willem A
authors: WA
authors: Kamps
mesh_terms: D000293:Adolescent; D018931:Antineoplastic Agents, Hormonal / Q000009:adverse effects*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D003907:Dexamethasone / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008297:Male; D009894:Opportunistic Infections / Q000139:chemically induced* / Q000401:mortality; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000188:drug therapy* / Q000401:mortality; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D018931:Antineoplastic Agents, Hormonal; D003907:Dexamethasone