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High-dose methylprednisolone for children with acute lymphoblastic leukemia and unfavorable presenting features
G Hiçsönmez1, F Gümrük, P V Zamani
1Department of Pediatric Hematology, Ihsan Dogramaci Children's Hospital, Ankara, Turkey.
Insights
High-dose methylprednisolone (HDMP) improved remission rates in children with acute lymphoblastic leukemia (ALL). HDMP therapy showed a lower relapse rate and longer remission duration with well-tolerated side effects.
Area of Science:
- Pediatric Oncology
- Hematology
- Pharmacology
Background:
- Acute lymphoblastic leukemia (ALL) is a common childhood cancer.
- Standard steroid doses in ALL treatment can be associated with suboptimal outcomes in high-risk patients.
Purpose of the Study:
- To evaluate the efficacy and safety of high-dose methylprednisolone (HDMP) in children with high-risk ALL.
- To compare HDMP with conventional steroid dosing in combination with cytotoxic agents.
Main Methods:
- A cohort of 48 newly diagnosed high-risk ALL patients received HDMP (20-30 mg/kg/day orally) with vincristine and L-asparaginase.
- Outcomes were compared to 86 historical controls receiving standard-dose steroids with the same regimen.
Main Results:
- Complete remission (CR) rate was 94% with HDMP versus 81% in controls.
- Bone marrow relapse rate was significantly lower with HDMP (31% vs. 56%).
- Five-year continuous CR rate was higher with HDMP (60% vs. 43%), with shorter leukopenia duration and no significant adverse effects.
Conclusions:
- HDMP, combined with antileukemic agents, improves CR rates and remission duration in high-risk pediatric ALL.
- Further randomized studies are needed to determine optimal HDMP dosage and its role in maintenance therapy.
Abstract:
In an attempt to improve treatment outcome high-dose methylprednisolone (HDMP, 20-30 mg/kg, once a day orally) was used instead of a conventional dose of steroid (2 mg/kg/d, in 3 divided doses) in children with acute lymphoblastic leukemia (ALL) with increased risk factors. HDMP combined with cytotoxic agents (vincristine and L-asparaginase) resulted in an improved complete remission rate (94%) in 48 newly diagnosed children with ALL compared to 81% in 86 historical controls receiving standard dose steroid combined with the same treatment regimen. The bone marrow relapse rate was lower in patients who received HDMP (31%) than in controls (56%). Treatment was discontinued in 56% of 48 patients receiving HDMP and in 35% of 86 controls. The difference was significant (p < 0.05). The 5-yr continuous complete remission rate was significantly greater in patients received HDMP compared with the control patients (60% vs. 43%, p < 0.05). HDMP treatment was well tolerated without significant adverse effects. Moreover, during induction therapy the duration of leukopenia (< 2 x 10(9)/L) was shorter in patients receiving HDMP. We conclude that HDMP combined with other antileukemic agents increased the CR rate and prolonged the duration of remission in children with ALL who had increased risk factors. However, the optimal dosage of HDMP and its role in maintenance therapy should be determined in future, randomized studies.