title: A comparison of neurocognitive functioning in children previously randomized to dexamethasone or prednisone in the treatment of childhood acute lymphoblastic leukemia.
abstract: In previous clinical trials of childhood acute lymphoblastic leukemia (ALL), dexamethasone resulted in higher event-free survival rates than prednisone, presumably due to greater central nervous system penetration. Dexamethasone's association with long-term neurocognitive toxicity is unknown. In this multisite study, we measured neurocognitive functioning in 92 children with standard-risk ALL, 1 to 9.99 years at diagnosis, at a mean of 9.8 years after randomization to prednisone (n = 41) or dexamethasone (n = 51) on Children's Cancer Group (CCG) 1922. No significant overall differences in mean neurocognitive and academic performance scores were found between the prednisone and dexamethasone groups after adjusting for age, sex, and time since diagnosis. The exception was that patients receiving dexamethasone scored one-third of a standard deviation worse on word reading (98.8 +/- 1.7 vs 104.9 +/- 1.8; P = .02). There were no group differences in the distribution of test scores or the parents' report of neurologic complications, psychotropic drug use, and special education. Further analyses suggested for the dexamethasone group, older age of diagnosis was associated with worse neurocognitive functioning; for the prednisone group, younger age at diagnosis was associated with worse functioning. In conclusion, our study did not demonstrate any meaningful differences in long-term cognitive functioning of childhood ALL patients based on corticosteroid randomization. This study is registered with http://www.clinicaltrials.gov under NCT00085176.
authors: Yale University School of Medicine and Yale Cancer Center, New Haven, CT, USA. nina.kadan-lottick@yale.edu
authors: Nina S
authors: NS
authors: Kadan-Lottick
authors: Pim
authors: P
authors: Brouwers
authors: David
authors: D
authors: Breiger
authors: Thomas
authors: T
authors: Kaleita
authors: James
authors: J
authors: Dziura
authors: Haibei
authors: H
authors: Liu
authors: Lu
authors: L
authors: Chen
authors: Megan
authors: M
authors: Nicoletti
authors: Linda
authors: L
authors: Stork
authors: Bruce
authors: B
authors: Bostrom
authors: Joseph P
authors: JP
authors: Neglia
mesh_terms: D018931:Antineoplastic Agents, Hormonal / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D003071:Cognition; D003430:Cross-Sectional Studies; D003907:Dexamethasone / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D009483:Neuropsychological Tests; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000150:complications* / Q000188:drug therapy*; D011241:Prednisone / Q000009:adverse effects*; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome
chemical_list: D018931:Antineoplastic Agents, Hormonal; D003907:Dexamethasone; D011241:Prednisone