Efficacy and safety of dexamethasone and prednisone for therapy in childhood acute lymphoblastic leukemia: A systematic review and meta-analysis.

Authors

Wenqiong Lv, Dongjun Li, Jianhua Li, Yao Xie, Xue Yang

Published in

Clinical and investigative medicine. Medecine clinique et experimentale. Volume 49. Issue 2. Pages 43-55. Epub Jul 13, 2026.

Abstract

This meta-analysis examined the efficacy and safety of dexamethasone compared with prednisone in the treatment of acute lymphoblastic leukemia (ALL).
A search was conducted in PubMed, EMBASE, and the Cochrane Library databases for randomized controlled trials (RCTs) or observational studies involving children diagnosed with ALL who received dexamethasone or prednisone as pharmacotherapy. Studies without access to primary data were excluded. RCTs were assessed using the Cochrane Risk of Bias 2.0 tool, while observational studies were evaluated with ROBINS-I.
Fourteen studies involving 12,665 children were analyzed. Dexamethasone significantly improved event-free survival compared to prednisone (OR 1.40 [95% CI 1.26 to 1.56], P < 0.001). However, the pooled results, which showed significant heterogeneity, indicated a potentially higher incidence of toxicity associated with dexamethasone (OR 1.92 [95% CI 1.32 to 2.81]), a finding that warrants cautious interpretation. Qualitative synthesis further clarified that this increased risk was particularly evident for infectious, neuropsychiatric, and musculoskeletal adverse events. No significant differences were found in remission rates, relapse rates, or mortality between the two glucocorticoids. The GRADE assessment indicated high certainty regarding the evidence for event-free survival.
In children with ALL, dexamethasone improves event-free survival compared to prednisone but may have a higher risk of adverse effects. This highlights the need for a careful benefit-risk assessment. Future research should explore hybrid glucocorticoid strategies to maximize survival outcomes while reducing adverse effects.

PMID:
42446908
Bibliographic data and abstract were imported from PubMed on 14 Jul 2026.

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