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Behavioral effects of corticosteroids in children with acute lymphoblastic leukemia
R Drigan1, A Spirito, R D Gelber
1Dana Farber Cancer Institute, Boston, MA 02115.
Insights
Corticosteroids in acute lymphoblastic leukemia treatment can cause behavioral changes in children. High-risk patients experienced more emotional lability and mood changes, but steroid dose alone wasn
Area of Science:
- Pediatric Oncology
- Child Psychology
- Pharmacology
Background:
- Corticosteroids are integral to acute lymphoblastic leukemia (ALL) chemotherapy.
- Behavioral side effects of corticosteroids in pediatric cancer patients require thorough investigation.
- Understanding treatment-related behavioral changes is crucial for supportive care in childhood ALL.
Purpose of the Study:
- To evaluate the behavioral impact of corticosteroid treatment in children with standard-risk and high-risk acute lymphoblastic leukemia.
- To compare behavioral changes between standard-risk and high-risk ALL patients receiving corticosteroids.
- To determine the influence of steroid dose and chemotherapy regimen on observed behavioral effects.
Main Methods:
- Behavioral assessments of 38 children with ALL (standard-risk N=17, high-risk N=21) during corticosteroid treatment.
- Parental reports collected over 4 weeks (pre-treatment, during, and 2 weeks post-treatment) covering emotional lability, attention, sleep, mood, and peer relations.
- Two assessment points: 16 weeks post-remission and 1 year post-remission, with varying treatment parameters at each point.
Main Results:
- Significant behavioral changes (emotional lability, attention, sleep, listlessness, peer relations, depressed mood) were observed during corticosteroid treatment for both risk groups.
- High-risk ALL patients showed greater emotional lability, listlessness, and depressed mood compared to standard-risk patients at 16 weeks, when treatment regimens differed significantly.
- Steroid dose alone did not appear to be the primary driver of behavioral changes at the tested doses; concomitant chemotherapy likely played a role.
Conclusions:
- Corticosteroid therapy in pediatric ALL is associated with significant, albeit often transient, behavioral disturbances.
- Treatment intensity (steroid dose plus chemotherapy) influences the severity of behavioral effects, particularly in high-risk patients.
- Further research is needed to elucidate the specific mechanisms and long-term implications of these behavioral changes.
Abstract:
We evaluated the behavior of 38 children with standard-risk and high-risk acute lymphoblastic leukemia who received corticosteroids as part of their antileukemia chemotherapy. Each patient was assessed on two occasions: 16 weeks following remission and 1 year thereafter. Parent reports on emotional lability, attention span/hyperactivity, sleep disturbance, listlessness, peer relations, and depressed mood were obtained for 4 consecutive weeks: week before, week during, and 2 weeks after treatment administration. At the 16 week evaluation, standard-risk (N = 17) and high-risk (N = 21) treatment differed by steroid dose and systemic chemotherapy, while at the 1 year testing, treatment differed only by steroid dose (prednisone 40 mg/m2 vs. 120 mg/m2). Statistically significant changes in all measures were observed during treatment as compared with before and after treatment for both risk groups and assessment times. High-risk patients exhibited greater behavioral effects than standard-risk patients only for emotional lability, listlessness, and depressed mood at the 16 week testing, when both steroid dose and chemotherapy differed. Girls had slightly greater behavioral effects than boys, while no influence of age was observed. At the doses tested, steroid dose per se does not appear to be the primary variable affecting behavioral changes.