title: Neuropsychological outcomes of a randomized trial of prednisone versus dexamethasone in acute lymphoblastic leukemia: findings from Dana-Farber Cancer Institute All Consortium Protocol 00-01.
abstract: BACKGROUND
  Dexamethasone is more efficacious than prednisone in the treatment of acute lymphoblastic leukemia (ALL), but has also been associated with greater toxicity. We compared neuropsychological outcomes for patients treated on DFCI ALL Consortium Protocol 00-01, which included a randomized comparison of the two steroid preparations during post-induction therapy in children and adolescents with ALL.
  
  
  METHODS
  Between 2000 and 2005, 408 children with standard-risk or high-risk ALL treated on Dana-Farber Cancer Institute Consortium Protocol 00-01 were randomly assigned to prednisone or dexamethasone administered as 5-day pulses every 3 weeks for 2 years, beginning at week 7 of treatment. Blinded neuropsychological testing was completed for 170 randomized patients (prednisone, N = 76; dexamethasone, N = 94), all of whom were in continuous complete remission after completion of therapy.
  
  
  RESULTS
  Outcomes were comparable for most variables, although patients on the dexamethasone arm performed more poorly on a measure of fluid reasoning (P = 0.02). They also tended to be more likely to be enrolled in special education (dexamethasone, 33% vs. prednisone, 20%, P = 0.09).
  
  
  CONCLUSIONS
  Dexamethasone has well documented benefit in treatment of ALL. Although formal testing provided little indication of increased risk for neurotoxicity relative to prednisone, the somewhat greater utilization of special education services by patients treated with dexamethasone merits further investigation.
authors.affiliation: Division of Psychology, Department of Psychiatry, Boston Children's Hospital, Boston, Massachusetts; Department of Psychiatry, Harvard Medical School, Boston, Massachusetts.
authors.forename: Deborah P
authors.initials: DP
authors.lastname: Waber
authors.forename: Marie
authors.initials: M
authors.lastname: McCabe
authors.forename: Mikaela
authors.initials: M
authors.lastname: Sebree
authors.forename: Peter W
authors.initials: PW
authors.lastname: Forbes
authors.forename: Heather
authors.initials: H
authors.lastname: Adams
authors.forename: Cheryl
authors.initials: C
authors.lastname: Alyman
authors.forename: Stephen A
authors.initials: SA
authors.lastname: Sands
authors.forename: Philippe
authors.initials: P
authors.lastname: Robaey
authors.forename: Ivonne
authors.initials: I
authors.lastname: Romero
authors.forename: Marie-Ève
authors.initials: MÈ
authors.lastname: Routhier
authors.forename: Jonathan M
authors.initials: JM
authors.lastname: Girard
authors.forename: Stephen E
authors.initials: SE
authors.lastname: Sallan
authors.forename: Lewis B
authors.initials: LB
authors.lastname: Silverman
mesh_terms: D000293:Adolescent; D000970:Antineoplastic Agents / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D003071:Cognition / Q000187:drug effects*; D003907:Dexamethasone / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D009483:Neuropsychological Tests; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000188:drug therapy*; D011241:Prednisone / Q000009:adverse effects*
chemical_list: D000970:Antineoplastic Agents; D003907:Dexamethasone; D011241:Prednisone
keywords: acute lymphoblastic leukemia; behavior; children; cognition; dexamethasone