Substituting dexamethasone for prednisone complicates remission induction in children with acute lymphoblastic leukemia

BACKGROUND, The authors report the occurrence of fatal or near-fatal sepsis in 16 of 38 children with newly diagnosed acute lymphoblastic leukemia (AL L] treated with a new induction regimen that differed from its predecessor by the substitution of dexamethasone for prednisone. METHODS. The frequency of septic deaths among 38 children who received mult iagent remission induction therapy, including dexamethasone (6 mg/m(2)) dai ly for 28 days (pilot protocol 91-01P), was compared with the frequency of septic deaths among children previously treated (protocol 87-01) and subseq uently treated (protocol 91-01) in consecutive Dana-Farber Cancer Institute (DFCI) ALL trials with induction therapy that included 21 and 28 days of p rednisone (40 mg/m(2)), respectively. Except for dexamethasone in protocol 91-01P, the remission induction agents used were identical in substance to those used in protocol 87-01. Protocol 91-01, the successor 91-01P, was als o similar, with the exception of the deletion of a single dose of L-asparag inase. RESULTS. Sixteen of the 38 children (42%) treated on the DFCI 91-01P had do cumented gram positive or gram negative sepsis (17 episodes] during remissi on induction, including 4 toxic deaths (11%). in contrast, there were 4 ind uction deaths among 369 children (1%) treated on protocol 87-01 (P = 0.0035 ) and 1 induction death among 377 children (<1%) treated on protocol 91-01 (P = 0.0003). CONCLUSIONS, Substitution of dexamethasone for prednisone or methylpredniso lone in an otherwise intensive conventional induction regimen for previousl y untreated children with ALL resulted in an alarmingly high incidence of s eptic episodes and toxic deaths. Awareness of this complication, considerin g that the substitution has no apparent benefit in the efficacy of remissio n induction, argues against its routine use in intensive induction regimens for children with ALL., Cancer 2000;88:1964-9, (C) 2000 American Cancer So ciety.