Prednisone and dexamethasone in acute lymphoblastic leukemia in children: which is the better option?

Modern therapy for childhood acute lymphoblastic leukemia (ALL) composes of multi-agent chemotherapy regimens. During remission induction therapy, systemic chemotherapy consists of three to four agents together with intrathecal chemotherapy. Among them, corticosteroid is one of the important anti-leukemic agents. Either prednisone (or prednisolone) or dexamethasone is being used in the remission-induction therapy in various single center or multi-center collaborative studies. At the earlier days of ALL treatment, prednisone was the first corticosteroid used in induction therapy. Interest in substituting dexamethasone for prednisone arise from subsequent studies which suggested dexamethasone having more potent anti-leukemia activity, and better central nervous system penetration. However it may be associated with more treatment related toxicities. The choice of corticosteroid, its optimal dose and duration of use within the regimen of childhood ALL therapy remained controversial (1,2).