We report an increased incidence of infectious deaths during maintenance treatment of the ninth protocol for acute lymphoblastic leukaemia of the Dutch Childhood Oncology Group (DCOG-ALL-9). The main difference in maintenance treatment between DCOG-ALL-9 and the DCOG-ALL-7 and DCOG-ALL-8 protocols is the interruption of methotrexate and 6-mercaptopurine by vincristine (2 mg/m2weekly) and dexamethasone (6 mg/m2daily) for 14 days every 7 weeks in the DCOG-ALL-9 protocol. The 1107 children treated with the DCOG-ALL-7, DCOG-ALL-8 or DCOG-ALL-9 protocol were included and screened for infectious death during maintenance treatment (July 1988-July 2002). Seven of the 510 children died of severe infections during the maintenance phase of DCOG-ALL-9, compared to none of the 597 patients during the DCOG-ALL-7 and DCOG-ALL-8 protocols (1.37% versus 0.0%; p = 0.013). Results from the current study suggest that repeated, prolonged exposure to dexamethasone results in an increase of lethal infections from 0% to 1.37%. In the dosing-schedule used, the advantage of dexamethasone may not outweigh the higher risk of infectious death.

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doi.org/10.1016/j.ejca.2007.07.002, hdl.handle.net/1765/36371
European Journal of Cancer
Erasmus MC: University Medical Center Rotterdam

te Poele, E., de Bont, E., Boezen, M., Révész, T., Bökkerink, J., Beishuizen, A., … Kamps, W. (2007). Dexamethasone in the maintenance phase of acute lymphoblastic leukaemia treatment: Is the risk of lethal infections too high?. European Journal of Cancer, 43(17), 2532–2536. doi:10.1016/j.ejca.2007.07.002