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. Issue 11 (6th July 2013)

• Record Type: Journal Article
• Authors: Waber, Deborah P.; McCabe, Marie; Sebree, Mikaela; Forbes, Peter W.; Adams, Heather; Alyman, Cheryl; Sands, Stephen A.; Robaey, Philippe; Romero, Ivonne; Routhier, Marie‐Ève; Girard, Jonathan M.; Sallan, Stephen E.; Silverman, Lewis B.
• Is Part Of: Pediatric blood & cancer. Volume 60:Issue 11(2013:Nov.)
• Page Start: 1785
• Page End: 1791
• Publication Date: 2013-07-06
• Subjects: Tumors in children -- Periodicals; Blood -- Diseases -- Periodicals; Cancer in children -- Periodicals; 618.92
• DOI: 10.1002/pbc.24666
• Languages: English
• ISSNs: 1545-5009

Abstract

<abstract abstract-type="main" xml:lang="en"> <title>Abstract</title> <sec id="pbc24666-sec-0001" sec-type="section"> <title>Background</title> <p>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.</p> </sec> <sec id="pbc24666-sec-0002" sec-type="section"> <title>Procedure</title> <p>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.</p> </sec> <sec id="pbc24666-sec-0003" sec-type="section"> <title>Results</title> <p>Outcomes were comparable for most variables, although patients on the dexamethasone arm performed more poorly on a measure of fluid reasoning (<italic>P</italic> = 0.02). They also tended to be more likely to be enrolled in special education (dexamethasone, 33% vs. prednisone, 20%, <italic>P</italic> = 0.09).</p> </sec> <sec id="pbc24666-sec-0004" sec-type="section"> <title>Conclusions</title> <p>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. Pediatr Blood Cancer 2013;60:1785–1791. © 2013 Wiley Periodicals, Inc.</p> </sec> </abstract>