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, Joseph P. Neglia

Research output: Contribution to journalArticle

49 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)1746-1752
Number of pages7
JournalBlood
Volume114
Issue number9
DOIs
StatePublished - 2009

Fingerprint

Prednisone
Precursor Cell Lymphoblastic Leukemia-Lymphoma
Dexamethasone
Random Allocation
Therapeutics
Special Education
Psychotropic Drugs
Neurology
Nervous System
Disease-Free Survival
Toxicity
Reading
Adrenal Cortex Hormones
Survival Rate
Central Nervous System
Age Groups
Education
Parents
Clinical Trials
Neoplasms

ASJC Scopus subject areas

  • Hematology
  • Biochemistry
  • Cell Biology
  • Immunology

Cite this

A comparison of neurocognitive functioning in children previously randomized to dexamethasone or prednisone in the treatment of childhood acute lymphoblastic leukemia. / Kadan-Lottick, Nina S.; Brouwers, Pim; Breiger, David; Kaleita, Thomas; Dziura, James; Liu, Haibei; Chen, Lu; Nicoletti, Megan; Stork, Linda; Bostrom, Bruce; Neglia, Joseph P.

In: Blood, Vol. 114, No. 9, 2009, p. 1746-1752.

Research output: Contribution to journalArticle

Kadan-Lottick, NS, Brouwers, P, Breiger, D, Kaleita, T, Dziura, J, Liu, H, Chen, L, Nicoletti, M, Stork, L, Bostrom, B & Neglia, JP 2009, 'A comparison of neurocognitive functioning in children previously randomized to dexamethasone or prednisone in the treatment of childhood acute lymphoblastic leukemia', Blood, vol. 114, no. 9, pp. 1746-1752. https://doi.org/10.1182/blood-2008-12-186502
Kadan-Lottick, Nina S. ; Brouwers, Pim ; Breiger, David ; Kaleita, Thomas ; Dziura, James ; Liu, Haibei ; Chen, Lu ; Nicoletti, Megan ; Stork, Linda ; Bostrom, Bruce ; Neglia, Joseph P. / A comparison of neurocognitive functioning in children previously randomized to dexamethasone or prednisone in the treatment of childhood acute lymphoblastic leukemia. In: Blood. 2009 ; Vol. 114, No. 9. pp. 1746-1752.
@article{9f8b39f7b9064be3b3a15f583897d31a,
title = "A comparison of neurocognitive functioning in children previously randomized to dexamethasone or prednisone in the treatment of childhood acute lymphoblastic leukemia",
abstract = "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.",
author = "Kadan-Lottick, {Nina S.} and Pim Brouwers and David Breiger and Thomas Kaleita and James Dziura and Haibei Liu and Lu Chen and Megan Nicoletti and Linda Stork and Bruce Bostrom and Neglia, {Joseph P.}",
year = "2009",
doi = "10.1182/blood-2008-12-186502",
language = "English (US)",
volume = "114",
pages = "1746--1752",
journal = "Blood",
issn = "0006-4971",
publisher = "American Society of Hematology",
number = "9",

}

TY - JOUR

T1 - A comparison of neurocognitive functioning in children previously randomized to dexamethasone or prednisone in the treatment of childhood acute lymphoblastic leukemia

AU - Kadan-Lottick, Nina S.

AU - Brouwers, Pim

AU - Breiger, David

AU - Kaleita, Thomas

AU - Dziura, James

AU - Liu, Haibei

AU - Chen, Lu

AU - Nicoletti, Megan

AU - Stork, Linda

AU - Bostrom, Bruce

AU - Neglia, Joseph P.

PY - 2009

Y1 - 2009

N2 - 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.

AB - 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.

UR - http://www.scopus.com/inward/record.url?scp=70349247009&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=70349247009&partnerID=8YFLogxK

U2 - 10.1182/blood-2008-12-186502

DO - 10.1182/blood-2008-12-186502

M3 - Article

C2 - 19546477

AN - SCOPUS:70349247009

VL - 114

SP - 1746

EP - 1752

JO - Blood

JF - Blood

SN - 0006-4971

IS - 9

ER -