Cognitive sequelae in children treated for acute lymphoblastic leukemia with dexamethasone or prednisone

Purpose: The cognitive sequelae of treatment for childhood acute lymphoblas tic leukemia (ALL) were compared in a group of patients who received dexame thasone during the intensification and maintenance phases of therapy with t hose in a historical control group for whom antileukemia therapy was simila r, 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 gi ven every 3 weeks during intensification acid continuation phases of therap y for a total of 2 years. Results: Children treated on protocol 87-01 received prednisone at a dose o f 40 mg/m(2)/d (standard risk, SR) or 120 mg/ m(2)/d (high risk, HR); those treated on protocol 91-01 received dexamethasone at a dose of 6 mg/m(2) pe r day (SR) or 18 mg/m2 per day (HR). Children treated on protocol 91-01 per formed less well on cognitive testing. Subsample analysis indicated that cr anial radiation therapy and methotrexate dose did not account for differenc es 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 investi gation of this question is warranted.