Unraveling Dexamethasone-Induced Neurobehavioral and Sleep Problems in Children With ALL: Which Determinants Are Important?

Autor:	van Hulst AM; Pediatric Oncology, Princess Máxima Center, Utrecht, the Netherlands., Grootenhuis MA; Pediatric Oncology, Princess Máxima Center, Utrecht, the Netherlands., Verwaaijen EJ; Pediatric Oncology, Princess Máxima Center, Utrecht, the Netherlands., van Litsenburg RRL; Pediatric Oncology, Princess Máxima Center, Utrecht, the Netherlands., Li L; Department of Hospital Pharmacy, Erasmus Medical Center, Rotterdam, the Netherlands., van Zelst BD; Division of Endocrinology, Department of Internal Medicine, Erasmus Medical Center, Rotterdam, the Netherlands., Broer L; Department of Internal Medicine, Erasmus Medical Center, Rotterdam, the Netherlands., Pluijm SMF; Pediatric Oncology, Princess Máxima Center, Utrecht, the Netherlands., Pieters R; Pediatric Oncology, Princess Máxima Center, Utrecht, the Netherlands., Fiocco M; Pediatric Oncology, Princess Máxima Center, Utrecht, the Netherlands.; Mathematical Institute, Leiden University, Leiden, the Netherlands.; Department of Biomedical Data Science, Medical Statistics, Leiden University Medical Centre, Leiden, the Netherlands., van den Akker ELT; Department of Pediatric Endocrinology, Erasmus MC- Sophia Children's Hospital, Rotterdam, the Netherlands., van den Heuvel-Eibrink MM; Pediatric Oncology, Princess Máxima Center, Utrecht, the Netherlands.; Child Health, UMCU-Wilhelmina Children's Hospital, Utrecht, the Netherlands.
Jazyk:	angličtina
Zdroj:	JCO precision oncology [JCO Precis Oncol] 2023 Jun; Vol. 7, pp. e2200678.
DOI:	10.1200/PO.22.00678
Abstrakt:	Purpose: Dexamethasone, the preferred corticosteroid in most treatment protocols for pediatric acute lymphoblastic leukemia (ALL), can induce undesirable side effects. Neurobehavioral and sleep problems are frequently reported, but the interpatient variability is high. We therefore aimed to identify determinants for parent-reported dexamethasone-induced neurobehavioral and sleep problems in pediatric ALL. Methods: Our prospective study included patients with medium-risk ALL and their parents during maintenance treatment. Patients were assessed before and after one 5-day dexamethasone course. Primary end points were parent-reported dexamethasone-induced neurobehavioral and sleep problems, measured with the Strengths and Difficulties Questionnaire and Sleep Disturbance Scale for Children, respectively. Analyzed determinants included patient and parent demographics, disease and treatment characteristics, parenting stress (Parenting Stress Index and Distress Thermometer for Parents), dexamethasone pharmacokinetics, and genetic variation (candidate single-nucleotide polymorphisms rs41423247 and rs4918 ). Statistically significant determinants identified in univariable logistic regression analyses were incorporated in a multivariable model. Results: We included 105 patients: median age was 5.4 years (range, 3.0-18.8) and 61% were boys. Clinically relevant dexamethasone-induced neurobehavioral and sleep problems were reported by parents in 70 (67%) and 61 (59%) patients, respectively. In our multivariable regression models, we identified parenting stress as a significant determinant for parent-reported neurobehavioral (odds ratio [OR], 1.16; 95% CI, 1.07 to 1.26) and sleep problems (OR, 1.06; 95% CI, 1.02 to 1.10). Furthermore, parents who experienced more stress before start of a dexamethasone course reported more sleep problems in their child (OR, 1.16; 95% CI, 1.02 to 1.32). Conclusion: We identified parenting stress, and not dexamethasone pharmacokinetics, genetic variation, patient/parent demographics, or disease/treatment characteristics, as a significant determinant for parent-reported dexamethasone-induced neurobehavioral and sleep problems. Parenting stress may be a modifiable target to reduce these problems.
Databáze:	MEDLINE
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