Comparison of steroid-associated adverse events between reinduction phases in JACLS ALL02 and JPLSG ALL-B12: a single-center retrospective study

Abstract

Both prednisolone and dexamethasone play crucial roles in the treatment of acute lymphoblastic leukemia (ALL); however, they are associated with various complications. We compared the adverse events associated with two steroid-containing protocols (prednisolone, 40 mg/m²/day for 2 weeks and dexamethasone, 10 mg/m²/day for 2 weeks) used in the re-induction phase of the treatment of newly diagnosed B-cell precursor ALL in 56 consecutive children treated at our institution between 2009 and 2017. The first 26 patients (ALL02 group) diagnosed before 2012 received 26 courses of chemotherapy, including prednisolone in the re-induction phase, and the remaining 30 patients (B12 group) diagnosed from 2012 to 2017 received 56 courses of chemotherapy, including dexamethasone in the re-induction phase. The symptoms and laboratory findings during the re-induction phase were compared between these patient groups on the basis of their medical records. Liver dysfunction, hypercholesterolemia, hypoproteinemia, obesity, febrile neutropenia, and glucose intolerance were more frequent in the B12 group than in the ALL02 group. Fibrates for hypercholesterolemia were frequently used in the B12 group; furthermore, abnormal glucose tolerance requiring insulin administration occurred only in the B12 group. Active prevention and early treatment should be considered for patients treated with dexamethasone in the re-induction phase of ALL therapy as dexamethasone use was found to be associated with a higher incidence of steroid-associated adverse events than prednisolone use.