{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,1]],"date-time":"2026-08-01T17:53:12Z","timestamp":1785606792129,"version":"3.56.0"},"reference-count":53,"publisher":"Wiley","issue":"24","license":[{"start":{"date-parts":[[2023,12,9]],"date-time":"2023-12-09T00:00:00Z","timestamp":1702080000000},"content-version":"vor","delay-in-days":8,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100006244","name":"Stichting Kinderen Kankervrij","doi-asserted-by":"publisher","award":["268"],"award-info":[{"award-number":["268"]}],"id":[{"id":"10.13039\/501100006244","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Cancer Medicine"],"published-print":{"date-parts":[[2023,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Dexamethasone is important in the treatment for pediatric acute lymphoblastic leukemia (ALL) but induces muscle atrophy with negative consequences for muscle mass, muscle strength, and functional abilities. The aim of this study was to establish the effect of a dexamethasone course on sarcopenia and physical frailty in children with ALL, and to explore prognostic factors.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Patients with ALL aged 3\u201318\u2009years were included during maintenance therapy. Patients had a sarcopenia\/frailty assessment on the first day of (T1) and on the day after (T2) a 5\u2010day dexamethasone course. Sarcopenia was defined as low muscle strength in combination with low muscle mass. Prefrailty and frailty were defined as having two or \u2265three of the following components, respectively: low muscle mass, low muscle strength, fatigue, slow walking speed, and low physical activity. Chi\u2010squared and paired <jats:italic>t<\/jats:italic>\u2010tests were used to assess differences between T1 and T2. Logistic regression models were estimated to explore patient\u2010 and therapy\u2010related prognostic factors for frailty on T2.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>We included 105 patients, 61% were boys. Median age was 5.3\u2009years (range: 3\u201318.8). At T1, sarcopenia, prefrailty, and frailty were observed in respectively 2.8%, 23.5%, and 4.2% of patients. At T2, the amount of patients with frailty had increased to 17.7% (<jats:italic>p<\/jats:italic>\u2009=\u20090.002), whereas the number of patients with sarcopenia and prefrailty remained similar. Higher ASMM (odds ratio [OR]: 0.49, 95% CI: 0.28\u20130.83), stronger handgrip strength (OR: 0.41, 95% CI: 0.22\u20130.77) and more physical activity minutes per day (OR: 0.98, 95% CI: 0.96\u20130.99) decreased the risk of frailty at T2. Slower walking performance (OR: 2, 95% CI: 1.2\u20133.39) increased the risk. Fatigue levels at T1 were not associated with frailty at T2.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Physical frailty increased strikingly after a 5\u2010days dexamethasone course in children with ALL. Children with poor physical state at start of the dexamethasone course were more likely to be frail after the course.<\/jats:p><\/jats:sec>","DOI":"10.1002\/cam4.6779","type":"journal-article","created":{"date-parts":[[2023,12,9]],"date-time":"2023-12-09T08:14:45Z","timestamp":1702109685000},"page":"22304-22315","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":15,"title":["Physical frailty deteriorates after a 5\u2010day dexamethasone course in children with acute lymphoblastic leukemia, results of a national prospective study"],"prefix":"10.1002","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1350-3363","authenticated-orcid":false,"given":"Emma J.","family":"Verwaaijen","sequence":"first","affiliation":[{"name":"Princess M\u00e1xima Center for Pediatric Oncology  Utrecht The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Annelienke M.","family":"van Hulst","sequence":"additional","affiliation":[{"name":"Princess M\u00e1xima Center for Pediatric Oncology  Utrecht The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Annelies","family":"Hartman","sequence":"additional","affiliation":[{"name":"Department of Pediatric Physiotherapy Erasmus Medical Center\u2010Sophia Children's Hospital  Rotterdam The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rob","family":"Pieters","sequence":"additional","affiliation":[{"name":"Princess M\u00e1xima Center for Pediatric Oncology  Utrecht The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marta","family":"Fiocco","sequence":"additional","affiliation":[{"name":"Princess M\u00e1xima Center for Pediatric Oncology  Utrecht The Netherlands"},{"name":"Mathematical Institute Leiden University  Leiden The Netherlands"},{"name":"Department of Biomedical Data Science, Section Medical Statistics Leiden University Medical Center  Leiden The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Saskia M. 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