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High remission rate in acute myeloblastic leukemia in children treated with high-dose methylprednisolone
G Hicsönmez1, N Karadeniz, V P Zamani
1Department of Pediatric Hematology, Hacettepe University, Children's Hospital, Ankara, Turkey.
Abstract:
Since the differentiating effect of high-dose methylprednisolone (HDMP) on myeloid leukemic cells has been shown in one of our patients with acute myeloblastic leukemia (AML-M4), 27 previously untreated children with AML were given HDMP (20-30 mg/kg per day) combined with cytosine arabinoside (Ara-C; 3 mg/kg) for the first 2 weeks of induction therapy. Marked clinical improvement was observed in all patients with the exception of one who died within 24 hours of the treatment. Enlarged liver and spleen (greater than 5 cm) became nonpalpable in 3 (37%) out of 8 and 5 (100%) out of 5 patients, respectively, and bone marrow blasts decreased below 5% in 7 patients (27%) within 2 wk of HDMP and Ara-C treatment. Adriamycin (1 mg/kg) was added 2 wk after initiation of induction therapy. Twenty-two (84.6%) of the 26 patients achieved complete remission, 3 (11.5%) had partial remission and no response was obtained in one. Treatment was well tolerated. The addition of HDMP as a differentiating and/or cytolytic agent to conventional anti-leukemic chemotherapy increased the complete remission rate and prolonged the duration of remission of our AML patients.
Insights
High-dose methylprednisolone (HDMP) combined with chemotherapy significantly improved remission rates in children with acute myeloblastic leukemia (AML). This novel approach offers a promising new treatment strategy for pediatric AML patients.
Area of Science:
- Pediatric Oncology
- Hematology
- Pharmacology
Background:
- Acute myeloblastic leukemia (AML) is a significant challenge in pediatric oncology.
- The differentiating effect of high-dose methylprednisolone (HDMP) on myeloid leukemic cells was previously observed.
Purpose of the Study:
- To evaluate the efficacy of combining HDMP with conventional chemotherapy in previously untreated pediatric AML patients.
- To assess the impact of HDMP as a differentiating and/or cytolytic agent in AML induction therapy.
Main Methods:
- Twenty-seven previously untreated children with AML received induction therapy.
- Treatment included high-dose methylprednisolone (HDMP) and cytosine arabinoside (Ara-C) for the first two weeks.
- Adriamycin was added after two weeks; treatment outcomes were monitored.
Main Results:
- Marked clinical improvement was observed in most patients.
- Significant reductions in hepatosplenomegaly and bone marrow blasts were noted within two weeks.
- A complete remission rate of 84.6% was achieved in 26 patients; treatment was well tolerated.
Conclusions:
- The addition of HDMP to conventional chemotherapy significantly increased the complete remission rate in pediatric AML.
- HDMP demonstrated differentiating and/or cytolytic activity, enhancing anti-leukemic effects.
- This combination therapy represents a promising strategy for improving outcomes in pediatric AML.