van Beek Robert D, de Muinck Keizer-Schrama Sabine M P F, Hakvoort-Cammel Friederike G, van der Sluis Inge M, Krenning Eric P, Pieters Rob, van den Heuvel-Eibrink Marry M
Department of Pediatric Hematology/Oncology, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands.
Pediatr Blood Cancer. 2006 Jan;46(1):88-93. doi: 10.1002/pbc.20437.
Dexamethasone is known to have both more potent leukemic activity and is associated with a higher incidence of side effects than prednisolone. In this study, we compared the long-term effects of dexamethasone and prednisolone on bone mineral density (BMD), body composition and growth in long-term survivors of ALL in first complete remission.
Ninety patients (51 male, 49 female; 8.6-38.5 year), treated with either a prednisolone containing protocol (n = 47; n = 19 also with CNS-irradiation) or a dexamethasone containing protocol (n = 43; no cranial irradiation) participated in this cross-sectional single center study. Mean follow-up was 12.7 years (2.0-29.7 years). BMD of lumbar spine and total body, and body composition were expressed as standard deviation scores (SDS) using dual energy X-ray absorptiometry. Bone mineral apparent density of the lumbar spine (BMAD) was calculated to correct for bone size.
There was no difference in height, height corrected for target height, BMD, or lean body mass between prednisolone and dexamethasone treated patients. Prednisolone treated patients had an increased percentage body fat (SDS +0.46; P < 0.05) and increased body mass index (SDS 0.88; P < 0.01) compared to normal. Dexamethasone treated patients had only an increased body mass index (SDS 0.52; P < 0.05). Height, total body BMD, and lean body mass were lower in patients treated with cranial irradiation as compared to non-irradiated patients, but differences in the latter two disappeared when corrected for height. BMAD was normal after CNS-irradiation.
Long term survivors of ALL treated with prednisolone or dexamethasone containing regimens do not differ in height, BMD, or body composition.
已知地塞米松具有更强的白血病活性，且与比泼尼松龙更高的副作用发生率相关。在本研究中，我们比较了地塞米松和泼尼松龙对首次完全缓解的急性淋巴细胞白血病（ALL）长期存活者骨密度（BMD）、身体成分和生长的长期影响。
90例患者（51例男性，49例女性；年龄8.6 - 38.5岁）参与了这项横断面单中心研究，这些患者接受了含泼尼松龙方案治疗（n = 47；其中19例还接受了中枢神经系统照射）或含地塞米松方案治疗（n = 43；未进行颅脑照射）。平均随访时间为12.7年（2.0 - 29.7年）。使用双能X线吸收法将腰椎和全身的骨密度以及身体成分表示为标准差分数（SDS）。计算腰椎的骨矿物质表观密度（BMAD）以校正骨大小。
泼尼松龙治疗组和地塞米松治疗组患者在身高、校正目标身高后的身高、骨密度或去脂体重方面无差异。与正常情况相比，泼尼松龙治疗组患者的体脂百分比增加（SDS +0.46；P < 0.05），体重指数增加（SDS 0.88；P < 0.01）。地塞米松治疗组患者仅体重指数增加（SDS 0.52；P < 0.05）。与未接受照射的患者相比，接受颅脑照射的患者身高、全身骨密度和去脂体重较低，但在根据身高校正后，后两者的差异消失。中枢神经系统照射后BMAD正常。
接受含泼尼松龙或地塞米松方案治疗的ALL长期存活者在身高、骨密度或身体成分方面无差异。
