Dexamethasone versus prednisone for induction therapy in childhood acute lymphoblastic leukemia: A systematic review and meta-analysis
Leukemia, 05/03/2011  Clinical Article

Teuffel O et al. – 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.

• Systematic review and meta-analysis compared efficacy and toxicity of DEX versus PRED for induction therapy in childhood ALL
• Searched biomedical literature databases and conference proceedings for randomized controlled trials comparing DEX and PRED during induction therapy for childhood ALL
• Meta-analysis
• 8 studies eligible for inclusion

• 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% 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 higher risk of mortality during induction (RR 2.31; 95% CI, 1.46–3.66), neuro-psychiatric AEs (RR 4.55; 95% CI, 2.45–8.46) and myopathy (RR 7.05; 95% CI, 3.00–16.58)
• No statistically significant difference in risk of osteonecrosis, sepsis, fungal infection, diabetes or pancreatitis
• DEX in induction therapy for children with ALL is more efficacious than PRED
• No statistically significant difference in risk of osteonecrosis, sepsis, fungal infection, diabetes or pancreatitis