Abstract
Purpose:
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.
Publication types
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Clinical Trial
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Comparative Study
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Randomized Controlled Trial
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Research Support, Non-U.S. Gov't
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Research Support, U.S. Gov't, P.H.S.
MeSH terms
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Antineoplastic Agents, Hormonal / administration & dosage
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Antineoplastic Agents, Hormonal / adverse effects*
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Antineoplastic Combined Chemotherapy Protocols / adverse effects
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Antineoplastic Combined Chemotherapy Protocols / therapeutic use*
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Asparaginase / administration & dosage
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Child
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Cognition Disorders / chemically induced*
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Cognition Disorders / etiology
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Combined Modality Therapy
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Cranial Irradiation / adverse effects
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Cytarabine / administration & dosage
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Dexamethasone / administration & dosage
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Dexamethasone / adverse effects*
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Doxorubicin / administration & dosage
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Educational Measurement
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Female
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Humans
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Injections, Spinal
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Learning Disabilities / chemically induced
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Learning Disabilities / etiology
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Leucovorin / administration & dosage
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Male
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Memory Disorders / chemically induced
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Memory Disorders / etiology
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Mercaptopurine / administration & dosage
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Methotrexate / administration & dosage
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Methotrexate / adverse effects
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Neuropsychological Tests
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Precursor Cell Lymphoblastic Leukemia-Lymphoma / complications
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Precursor Cell Lymphoblastic Leukemia-Lymphoma / drug therapy*
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Precursor Cell Lymphoblastic Leukemia-Lymphoma / psychology
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Precursor Cell Lymphoblastic Leukemia-Lymphoma / radiotherapy
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Prednisone / administration & dosage
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Prednisone / adverse effects
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Remission Induction
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Stress, Physiological / metabolism
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Stress, Physiological / psychology
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Vincristine / administration & dosage
Substances
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Antineoplastic Agents, Hormonal
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Cytarabine
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Vincristine
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Dexamethasone
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Doxorubicin
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Mercaptopurine
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Asparaginase
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Leucovorin
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Prednisone
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Methotrexate