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Blood, 27 August 2009, Vol. 114, No. 9, pp. 1746-1752. Prepublished online as a Blood First Edition Paper on June 22, 2009; DOI 10.1182/blood-2008-12-186502. This Article Full Text Full Text (PDF) Supplemental Appendix All Versions of this Article: blood-2008-12-186502v1 114/9/1746    most recent Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Rights and Permissions Citing Articles Citing Articles via CrossRef Google Scholar Articles by Kadan-Lottick, N. S. Articles by Neglia, J. P. PubMed PubMed Citation Articles by Kadan-Lottick, N. S. Articles by Neglia, J. P. Related Collections Free Research Articles Lymphoid Neoplasia Clinical Trials and Observations Social Bookmarking                   What's this?  Previous Article  |  Table of Contents  |  Next Article  CLINICAL TRIALS AND OBSERVATIONS A comparison of neurocognitive functioning in children previously randomized to dexamethasone or prednisone in the treatment of childhood acute lymphoblastic leukemia Nina S. Kadan-Lottick1, Pim Brouwers2, David Breiger3, Thomas Kaleita4, James Dziura5, Haibei Liu5, Lu Chen6, Megan Nicoletti1, Linda Stork7, Bruce Bostrom8, and Joseph P. Neglia9 1 Yale University School of Medicine and Yale Cancer Center, New Haven, CT; 2 Texas Children's Cancer Center, Houston, and National Institute of Mental Health, Rockville, MD; 3 University of Washington School of Medicine, Seattle; 4 David Geffen School of Medicine at University of California, Los Angeles; 5 Yale Center for Clinical Investigation, New Haven, CT; 6 Children's Oncology Group Operations Center, Arcadia, CA; 7 Oregon Health & Science University, Portland; 8 Children's Hospitals and Clinics, Minneapolis, MN; and 9 University of Minnesota Medical School, Minneapolis In previous clinical trials of childhood acute lymphoblastic leukemia (ALL), dexamethasone resulted in higher event-free survival rates than prednisone, presumably due to greater central nervous system penetration. Dexamethasone's association with long-term neurocognitive toxicity is unknown. In this multisite study, we measured neurocognitive functioning in 92 children with standard-risk ALL, 1 to 9.99 years at diagnosis, at a mean of 9.8 years after randomization to prednisone (n = 41) or dexamethasone (n = 51) on Children's Cancer Group (CCG) 1922. No significant overall differences in mean neurocognitive and academic performance scores were found between the prednisone and dexamethasone groups after adjusting for age, sex, and time since diagnosis. The exception was that patients receiving dexamethasone scored one-third of a standard deviation worse on word reading (98.8 ± 1.7 vs 104.9 ± 1.8; P = .02). There were no group differences in the distribution of test scores or the parents' report of neurologic complications, psychotropic drug use, and special education. Further analyses suggested for the dexamethasone group, older age of diagnosis was associated with worse neurocognitive functioning; for the prednisone group, younger age at diagnosis was associated with worse functioning. In conclusion, our study did not demonstrate any meaningful differences in long-term cognitive functioning of childhood ALL patients based on corticosteroid randomization. This study is registered with http://www.clinicaltrials.gov under NCT00085176 [ClinicalTrials.gov] . CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?

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