Study of exposure to dexamethasone among children with acute lymphoblastic leukemia and effect on intellectual function – A pilot study

Abstract

Background: There has been significant increase in the remission rates for childhood acute lymphoblastic leukemia (ALL) with addition of corticosteroids to chemotherapy regimens. However, with increase in survivors, there has been increase in the incidence of neurocognitive dysfunction as a 'long term sequelae. The present study was undertaken with the aim to study the effect of a chemotherapy regimen with dexamethasone on intellectual abilities in children with ALL. Methodology: This was a prospective, observational, and descriptive study conducted at a tertiary care hospital over a period of 18 months. Sixty children aged between 6 and 12 years diagnosed with B cell ALL and belonging to the standard risk ALL group on treatment protocol Pediatric Berlin-Frankfurt-Munster (1–10 years) (standard risk), initiated and maintained on oral dexamethasone as part of their chemotherapy regimen were recruited. All the patients were followed up for 6 months and assessed for intellectual ability using Raven's standard progressive matrices (SPM), which was carried out before starting oral dexamethasone, at 3 months and after 6 months of starting oral dexamethasone. Results: The scores obtained at three intervals were compared by one-way repeated analysis of variance and the results showed a significant increase in raw scores of SPM. The difference between the mean scores at the three specified intervals was statistically significant (P < 0.001). The overall maximum improvement (mean raw scores of 5.5) was seen over 6 months period in older age group (12 years). Gender-wise comparison of performance revealed an overall better scores in males, though the differences were not significant. Conclusion: The current study revealed a significant increase in raw scores of SPM in children with standard risk B cell ALL undergoing chemotherapy along with dexamethasone. However, randomized control studies with larger sample size followed up longitudinally for a longer period of time are needed for specific recommendations of using dexamethasone over other corticosteroids.