A prospective study of the hypothalamic-pituitary-adrenal axis in children with acute lymphoblastic leukemia receiving chemotherapy

作者：Salem Mona A; Tantawy Azza A^*; El Sedfy Haba H; El Laboudy Mohamed A; Toaima Dalia N; Mahmoud Nermine H; Selim Dalia M

来源：Hematology, 2015, 20(6): 320-327.

DOI：10.1179/1607845414Y.0000000208

• Hypothalamic-pituitary-adrenal axis
• Adrenal insufficiency
• Corticosteroids
• Acute lymphoblastic leukemia

Background: Glucocorticoids are essential in protocols of therapy of acute lymphoblastic leukemia (ALL).
Objectives: To assess the incidence, severity, morbidity, and risk factors of hypothalamic-pituitary-adrenal axis (HPA) suppression in children with ALL, and the time course of recovery.
Design: Forty standard risk ALL children treated in the Pediatric Hematology/Oncology Unit, Ain-Shams University, Egypt, were classified into dexamethasone (DXM) group: 20 patients on children cancer group protocol and prednisone (PDN) group: 20 patients on modified Berlin-Frankfurt-Muenster (BFM) study group 90 protocol. Patients were followed clinically and by laboratory assessment of morning s. ACTH, basal and after low-dose adrenocorticotrophic hormone stimulation test of cortisol and DHEAS, at diagnosis and every 2 weeks till adrenal recovery.
Results: HPA recovery was earlier in PDN than DXM group (P < 0.05). In induction phases 1 and 2: 65 and 75% of PDN group recovered on week 2, while 45 and 50% of DXM group recovered in week 4. Adrenal recovery was predicted 2 weeks earlier by normalized s. DHEAS. Children below 5 years of age had earlier recovery in PDN group (P = 0.04), no age effect in DXM group.
Conclusion: Adrenal suppression is an inevitable consequence of ALL therapy. Monitoring of cortisol levels and steroid coverage during stress is recommended, and gradual steroid tapering is suggested.

• 出版日期2015-7