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Dexamethasone versus prednisone for induction therapy in childhood acute lymphoblastic leukemia: a systematic review and meta-analysis

Leukemia volume 25, pages 1232–1238 (2011)Cite this article

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Abstract

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.

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Acknowledgements

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).

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Authors and Affiliations

  1. Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada

    O Teuffel, J Hitzler & L Sung

  2. Department of Microbiology, Mount Sinai Hospital, Toronto, Ontario, Canada

    S P Kuster

  3. The Children's Hospital and the Department of Pediatrics, University of Colorado Denver School of Medicine, Aurora, CO, USA

    S P Hunger

  4. Department of Pediatrics, University of Milano-Bicocca, Ospedale San Gerardo, Monza, Italy

    V Conter

  5. Department of Pediatrics, Ospedali Riuniti, Bergamo, Italy

    V Conter

  6. Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada

    M-C Ethier & L Sung

  7. Department of Pediatrics, Mount Sinai Hospital, Toronto, Ontario, Canada

    P S Shah

  8. Department of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada

    P S Shah, J Beyene & L Sung

  9. Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada

    J Beyene

  10. Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, Ontario, Canada

    J Beyene

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Teuffel, O., Kuster, S., Hunger, S. et al. Dexamethasone versus prednisone for induction therapy in childhood acute lymphoblastic leukemia: a systematic review and meta-analysis. Leukemia 25, 1232–1238 (2011). https://doi.org/10.1038/leu.2011.84

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