TY - JOUR
T1 - Dexamethasone versus prednisone for induction therapy in childhood acute lymphoblastic leukemia
T2 - A systematic review and meta-analysis
AU - Teuffel, O.
AU - Kuster, S. P.
AU - Hunger, S. P.
AU - Conter, V.
AU - Hitzler, J.
AU - Ethier, M. C.
AU - Shah, P. S.
AU - Beyene, J.
AU - Sung, L.
N1 - Funding Information:
We wish to thank Elizabeth Uleryk, the librarian from The Hospital for Sick Children in Toronto, who provided wonderful support for the literature search. A bursary from the Swiss Cancer League supports OT; SPH is the Ergen Family Chair in Pediatric Cancer; LS is supported by a New Investigator Award from the Canadian Institutes of Health Research (Grant No. 87719).
PY - 2011/8
Y1 - 2011/8
N2 - This systematic review and meta-analysis compared the efficacy and toxicity of dexamethasone (DEX) versus prednisone (PRED) for induction therapy in childhood acute lymphoblastic leukemia (ALL). We searched biomedical literature databases and conference proceedings for randomized controlled trials comparing DEX and PRED during induction therapy for childhood ALL. A total of eight studies were eligible for inclusion in this meta-analysis. DEX, in comparison with PRED, reduced events (that is, death from any cause, refractory or relapsed leukemia, or second malignancy; risk ratio (RR) 0.80; 95% confidence interval (CI), 0.68-0.94) and central nervous system relapse (RR 0.53; 95% CI, 0.44-0.65), but did not alter bone marrow relapse (RR 0.90; 95% CI, 0.69-1.18) or overall mortality (RR 0.91; 95% CI, 0.76-1.09). Patients receiving DEX had a higher risk of mortality during induction (RR 2.31; 95% CI, 1.46-3.66), neuro-psychiatric adverse events (RR 4.55; 95% CI, 2.45-8.46) and myopathy (RR 7.05; 95% CI, 3.00-16.58). There was no statistically significant difference in the risk of osteonecrosis, sepsis, fungal infection, diabetes or pancreatitis. DEX in induction therapy for children with ALL is more efficacious than PRED. However, DEX is also associated with more toxicity, and currently it remains unclear whether short-term superiority of DEX will also result in better overall survival.
AB - This systematic review and meta-analysis compared the efficacy and toxicity of dexamethasone (DEX) versus prednisone (PRED) for induction therapy in childhood acute lymphoblastic leukemia (ALL). We searched biomedical literature databases and conference proceedings for randomized controlled trials comparing DEX and PRED during induction therapy for childhood ALL. A total of eight studies were eligible for inclusion in this meta-analysis. DEX, in comparison with PRED, reduced events (that is, death from any cause, refractory or relapsed leukemia, or second malignancy; risk ratio (RR) 0.80; 95% confidence interval (CI), 0.68-0.94) and central nervous system relapse (RR 0.53; 95% CI, 0.44-0.65), but did not alter bone marrow relapse (RR 0.90; 95% CI, 0.69-1.18) or overall mortality (RR 0.91; 95% CI, 0.76-1.09). Patients receiving DEX had a higher risk of mortality during induction (RR 2.31; 95% CI, 1.46-3.66), neuro-psychiatric adverse events (RR 4.55; 95% CI, 2.45-8.46) and myopathy (RR 7.05; 95% CI, 3.00-16.58). There was no statistically significant difference in the risk of osteonecrosis, sepsis, fungal infection, diabetes or pancreatitis. DEX in induction therapy for children with ALL is more efficacious than PRED. However, DEX is also associated with more toxicity, and currently it remains unclear whether short-term superiority of DEX will also result in better overall survival.
KW - childhood leukemia
KW - corticosteroids
KW - toxicity
KW - treatment
UR - http://www.scopus.com/inward/record.url?scp=80051793838&partnerID=8YFLogxK
U2 - 10.1038/leu.2011.84
DO - 10.1038/leu.2011.84
M3 - Review article
C2 - 21527934
AN - SCOPUS:80051793838
SN - 0887-6924
VL - 25
SP - 1232
EP - 1238
JO - Leukemia
JF - Leukemia
IS - 8
ER -