Infectious toxicity of dexamethasone during all remission-induction chemotherapy: report of two cases and literature review.

Traditionally, children with acute lymphoblastic leukemia receive prednisone, as part of multiagent remission-induction chemotherapy. Recently, many cooperative groups use dexamethasone instead of prednisone during induction. We describe the infectious toxicities experienced by the first two patients in our institution treated with dexamethasone (10 mg/m(2)/day for 4 weeks with gradual tapering) during induction according to the dexamethasone arm of BFM 2000 and review the relevant literature that suggests an increased risk of infectious complications with dexamethasone. Only a prospective two-arm ALL dexamethasone study at two dose levels (6 and 10 mg/m(2)/day) will clarify if indeed the higher dose of dexamethasone during induction is more effective and without unacceptable toxicity.