A Study for Relation between the Side Effect of Reconsolidation Chemotherapy and the Use of Glucocorticoid in Childhood Acute Lymphoblastic Leukemia

Kim, Hak Yong; Kim, Ki Won; Chun, Jin Kyoung; Kwon, Ohgun; Kim, Hwang Min

Abstract

PURPOSE
After the introduction of delayed intensification (DI) therapy, the outcome of childhood acute lymphoblastic leukemia (ALL) have been improved. However, during reconsolidation, the side effect of anticancer drugs, such as myelosuppression, fever, hepatotoxicity, can be obstacles against the completion of DI. Generally, cytaraine (Ara-C) induced fever can be treated by steroids. Anticancer drugs, such as 6-mercaptopurine (6-MP), Ara-C, cyclophosphamide, can cause hepatotoxicity. The glucocorticoid is known to prevent apoptosis of hepatocyte. Therefore, we suspected that the use of dexamethasone during reconsolidation chemotherapy might reduce the incidence and severity of Ara-C induced fever and the drug induced hepatotoxicity.
METHODS
Ninety one weeks of reconsolidation were performed in 24 patients with ALL. Among 91 weeks, 46 weeks were composed of Ara-C, 6-MP, cyclophosphamide, and dexamethasone (Group A), 45 weeks were composed of Ara-C and 6-MP (Group B). We retrospectively analyzed the incidence and severity of chemotherapy induced leukopenia, fever and hepatotoxicity in 2 groups.
RESULTS
Both groups did not show any significant differences in aspects of drug induced leukopenia and fever. Leukopenia and fever of group A were seen in 31.8% (29 weeks) and 6.5% (6 weeks), which were not significantly different from those of group B, 30.7% (28 weeks) and 5.4% (5 weeks), respectively. CRP values of febrile patients were normal in both groups. Elevated aspartate aminotransferase (AST) and alanine aminotransferase (ALT) was shown in 19.8% (18 weeks) of Group A and 16.5% (15 weeks) of Group B, which showed no significant differences. The duration of elevated AST & ALT were 6.52+/-2.56 days in group A, 4.46+/-1.92 days in group B, which was statistically not significant.
CONCLUSION
The results of this study showed that the use of dexamethasone during reconsolidation chemotherapy did not prevent adverse effects of chemotherapy such as fever, hepatotoxicity and myelosuppression. However, insufficient dosage of glucocorticoid and the effects of other anti-cancer medicines compounded might have involved as confounding factors in our study.