Eiser Christine, Davies Helena, Jenney Meriel, Stride Chris, Glaser Adam
Cancer Research UK Professor of Child Health Psychology, Child and Family Research Group, Department of Psychology, University of Sheffield, Western Bank, Sheffield, United Kingdom.
Pediatr Blood Cancer. 2006 Jan;46(1):35-9. doi: 10.1002/pbc.20432.
Dexamethasone is increasingly used as the steroid of choice in trials for standard risk children with acute lymphoblastic leukemia (ALL). Improvements in event-free survival (EFS) have been attributed to lower CNS relapse rates, However, there are concerns that dexamethasone may be more toxic than previous conventional therapy with prednisone. Such toxicity raises questions about the implications for child neuropsychological function and HRQOL. Patients participating in the UK ALL 99/01 trial were randomized to receive dexamethasone or prednisone as their steroid in induction and maintenance chemotherapy. We compared the HRQOL and behavior in children randomized to receive both these agents.
Standardized questionnaires to assess parent and child HRQOL at 3-6 months after diagnosis (T1) and 1 year later (T2) completed by mothers in family homes. Forty-five mothers of a child with ALL (32 male, 13 female; average age at T1, 7 years 3 months; at T2, 8 years 3 months) completed HRQOL questionnaires.
For the total group, child HRQOL scores improved and behavior problems decreased significantly from T1 to T2. Comparison of HRQOL scores between the 17 children randomized to dexamethasone and 28 children randomized to prednisone showed no significant differences. The rate of improvement in HRQOL from T1 to T2 did not differ between children randomized to dexamethasone or prednisone.
Dexamethasone is increasingly used in the treatment of ALL and has been linked with improved survival rates. Long-term use of dexamethasone raises questions about neuropsychologic toxicity. Although HRQOL increased significantly over the year for all children, the extent of this increase did not differ by chemotherapy. These results should contribute to lessened concerns about use of dexamethasone in the treatment of ALL.
在标准风险的急性淋巴细胞白血病（ALL）儿童试验中，地塞米松越来越多地被用作首选类固醇药物。无事件生存期（EFS）的改善归因于较低的中枢神经系统复发率。然而，有人担心地塞米松可能比以前使用泼尼松的传统疗法毒性更大。这种毒性引发了关于对儿童神经心理功能和健康相关生活质量（HRQOL）影响的问题。参与英国ALL 99/01试验的患者在诱导和维持化疗中被随机分配接受地塞米松或泼尼松作为他们的类固醇药物。我们比较了随机接受这两种药物的儿童的HRQOL和行为。
由母亲在家庭中完成标准化问卷，以评估诊断后3 - 6个月（T1）和1年后（T2）的家长和儿童HRQOL。45名ALL患儿的母亲（32名男性，13名女性；T1时平均年龄7岁3个月；T2时8岁3个月）完成了HRQOL问卷。
对于整个组，儿童HRQOL评分从T1到T2有改善，行为问题显著减少。随机接受地塞米松的17名儿童和随机接受泼尼松的28名儿童之间的HRQOL评分比较显示无显著差异。随机接受地塞米松或泼尼松的儿童从T1到T2的HRQOL改善率没有差异。
地塞米松越来越多地用于ALL的治疗，并与生存率提高有关。地塞米松的长期使用引发了关于神经心理毒性的问题。尽管所有儿童的HRQOL在这一年中显著增加，但这种增加的程度在不同化疗药物之间没有差异。这些结果应有助于减少对在ALL治疗中使用地塞米松的担忧。
