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Early Response to Dexamethasone as Prognostic Factor: Result from Indonesian Childhood WK-ALL Protocol in Yogyakarta

Pudjo H Widjajanto1, Sutaryo Sutaryo, Ignatius Purwanto

  • 1Pediatric Hematology and Oncology Division, Department of Pediatrics, Dr. Sardjito Hospital, Medical Faculty, Universitas Gadjah Mada, Yogyakarta, Indonesia.

Journal of Oncology
|May 2, 2012
PubMed

Insights

Poor early response to childhood acute lymphoblastic leukemia (ALL) treatment, defined by high lymphoblast counts, occurred more frequently in Indonesian patients. This poor response correlated with worse treatment outcomes and survival rates.

Area of Science:

  • Pediatric Oncology
  • Hematology
  • Clinical Research

Background:

  • Early response to treatment is a critical prognostic indicator in childhood acute lymphoblastic leukemia (ALL) in Western cohorts.
  • Assessing early treatment response is vital for tailoring therapeutic strategies and predicting patient outcomes in ALL.
  • Limited data exists on the prognostic significance of early treatment response in low-income settings, particularly in Southeast Asia.

Purpose of the Study:

  • To evaluate the prognostic value of early treatment response in Indonesian children with ALL treated on the WK-ALL-2000 protocol.
  • To compare the rate of poor early responders in Indonesia with that reported in Western studies.
  • To determine the association between early response and key treatment outcomes, including induction failure, disease resistance, disease-free survival (DFS), and event-free survival (EFS).

Main Methods:

  • Retrospective analysis of 165 pediatric ALL patients treated between 1999 and 2006 in a low-income Indonesian province.
  • Early response was defined as peripheral lymphoblast count <1000/μL after 7 days of oral dexamethasone and one intrathecal methotrexate (MTX).
  • Statistical analyses were performed to compare outcomes between good and poor early responders, considering known risk factors like age and white blood cell count.

Main Results:

  • A poor early response rate of 19.4% was observed in the Indonesian cohort.
  • Poor responders exhibited significantly higher rates of induction failure (53.1% vs. 23.3%) and resistant disease (15.6% vs. 4.5%) compared to good responders.
  • Significantly shorter 5-year disease-free survival (24.9%) and event-free survival (9.7%) were noted in poor responders versus good responders (48.6% and 26.3%, respectively).
  • The rate of poor responders in this setting was higher than typically reported in Western studies using prednisone/prednisolone.

Conclusions:

  • Early response to treatment is a significant prognostic factor for childhood ALL in the Indonesian setting, impacting survival outcomes.
  • The higher incidence of poor responders suggests potential differences in treatment efficacy or patient characteristics compared to Western populations.
  • While early response is valuable, its additive prognostic value over established factors like age and WBC count was limited for DFS and moderate for EFS in this study.

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