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

Leukemia, 05/03/2011

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.

Methods

  • 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

Results

  • 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

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