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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 (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 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. Social Bookmarking                   What's this?  Previous Article  |  Next Article  Submitted December 10, 2008 Accepted June 1, 2009 A comparison of neurocognitive functioning in children previously randomized to dexamethasone or prednisone in the treatment of childhood acute lymphoblastic leukemia Nina S. Kadan-Lottick*, Pim Brouwers, David Breiger, Thomas Kaleita, James Dziura, Haibei Liu, Lu Chen, Megan Nicoletti, Linda Stork, Bruce Bostrom, and Joseph P. Neglia Yale University School of Medicine & Yale Cancer Center, New Haven, CT, United States Texas Children's Cancer Center, Houston, TX & National Institute of Mental Health, Rockville, MD, United States University of Washington School of Medicine, Seattle, WA, United States David Geffen School of Medicine at UCLA, Los Angeles, CA, United States Yale Center for Clinical Investigation, New Haven, CT, United States Children's Oncology Group Operations Center, Arcadia, CA, United States Oregon Health & Science University, Portland, OR, United States Children's Hospitals and Clinics, Minneapolis, MN, United States University of Minnesota Medical School, Minneapolis, MN, United States * Corresponding author; email: nina.kadan-lottick{at}yale.edu. 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 multi-site study, we measured neurocognitive functioning in 92 children with standard risk ALL, 1-9.99 years at diagnosis, at a mean of 9.8 years after randomization to prednisone (n=41) or dexamethasone (n=51) on 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, gender, and time since diagnosis. The exception was that patients receiving dexamethasone scored a third of a standard deviation worse on Word Reading (98.8 ±1.7 vs. 104.9±1.8; p=0.02). There were no group differences in the distribution of test scores or the parents' report of neurological 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 www.clinicaltrials.gov under NCT00085176. CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?

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