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Murine Model of Leukemia Relapse to Induction Chemotherapy for Acute Lymphoblastic Leukemia
Published on: October 17, 2025
[Prognostic value of the initial response to corticosteroids for children with acute lymphoblastic leukemia]
Małgorzata J Klimza1, Danuta J Sońta-Jakimczyk
1Studium Doktoranckiego Wydziału Lekarskiego w Zabrzu.
Insights
Children with acute lymphoblastic leukemia (ALL) who show a good response to prednisone treatment have a significantly higher chance of long-term survival. This steroid response is a crucial factor for stratifying pediatric ALL patients into risk groups.
Area of Science:
- Pediatric Hematology Oncology
- Cancer Research
- Clinical Pediatrics
Background:
- Acute lymphoblastic leukemia (ALL) is the most common childhood cancer.
- Current prognostic factors for pediatric ALL may not be sufficient for optimal risk stratification.
- Early assessment of treatment response is vital for tailoring therapy.
Purpose of the Study:
- To analyze the association between early prednisone response and long-term event-free survival (EFS) in pediatric ALL patients.
- To determine if glucocorticosteroid response should be incorporated into prognostic models for childhood ALL.
Main Methods:
- Retrospective analysis of 179 children (aged 2-17) with ALL treated between 1986-1996.
- Patients were stratified into low and medium risk groups and treated per BFM-86/BFM-90 protocols.
- Categorized patients into good prednisone response (PGR) and poor prednisone response (PPR) groups based on day 8 of treatment.
Main Results:
- 89.9% of patients exhibited a good prednisone response (PGR), while 10.1% showed a poor response (PPR).
- The 15-year event-free survival (EFS) was 70% for the PGR group versus 39% for the PPR group (p = 0.006).
- Good early response to prednisone significantly correlated with a higher likelihood of durable remission and cure.
Conclusions:
- Early glucocorticosteroid response is a significant prognostic indicator in childhood ALL.
- Incorporating steroid response into risk stratification can improve treatment selection and outcomes for pediatric ALL patients.
- This finding emphasizes the importance of early treatment response assessment in managing childhood leukemias.
Abstract:
Leukemias are the most common malignant diseases in childhood, with acute lymphoblastic leukemia (ALL) being the most frequent subtype. Diagnosis and treatment of ALL remains an important issue in pediatric practice. The great variety of prognostic factors has been recognized and applied for the stratification into different risk groups and consequently for selection of the most appropriate treatment. The most significant prognostic factors include age, sex, white blood count at diagnosis, infiltration of the extramedullary organs, and central nervous system involvement. The experience of numerous pediatric hemato-oncology centers has shown that above-mentioned prognostic criteria are not sufficient and they emphasize the need for determination of the response to glucocorticosteroids at day 8 of treatment. A retrospective analysis of treatment results in childhood in ALL patients with regard to steroid response has been performed. The study aimed at analysis whether there is any association between the long-term event-free survival (EFS) in patients with good and poor response to prednisone. The study group consisted of 179 children, aged 2 to 17 years, qualified into low and medium risk groups, treated according to the BFM-86 and BFM-90 protocols in the Department of Pediatrics and Hematology of Silesian Center of Pediatrics in Zabrze between 1986 and 1996. In the study group, 89.9% (161) of children showed good prednisone response (PGR) as compared to 10.1% of children with poor response to steroids (PPR). Cumulative probability of 15-year EFS for the PGR group was 70% and significantly differed from EFS in PPR group (39%; p = 0.006). In the study group, the children showing good response to the initial treatment with prednisone have higher chance for durable remission and subsequent cure. In conclusion, response to glucocorticosteroids employed in the initial treatment of children with ALL, should be included in the stratification into prognostic groups.
