Benefit of dexamethasone compared with prednisolone for childhood acute lymphoblastic leukaemia: results of the UK Medical Research Council ALL97 randomized trial.

2.50
Hdl Handle:
http://hdl.handle.net/10541/74887
Title:
Benefit of dexamethasone compared with prednisolone for childhood acute lymphoblastic leukaemia: results of the UK Medical Research Council ALL97 randomized trial.
Authors:
Mitchell, Christopher D; Richards, Susan M; Kinsey, Sally E; Lilleyman, John S; Vora, Ajay J; Eden, Tim O B
Abstract:
Corticosteroids are an essential component of treatment for acute lymphoblastic leukaemia (ALL). Prednisolone is the most commonly used steroid, particularly in the maintenance phase of therapy. There is increasing evidence that, even in equipotent dosage for glucocorticoid effect, dexamethasone has enhanced lymphoblast cytotoxicity and penetration of the central nervous system (CNS) compared with prednisolone. Substitution of dexamethasone for prednisolone in the treatment of ALL might, therefore, result in improved event-free and overall survival. Children with newly diagnosed ALL were randomly assigned to receive either dexamethasone or prednisolone in the induction, consolidation (all received dexamethasone in intensification) and continuation phases of treatment. Among 1603 eligible randomized patients, those receiving dexamethasone had half the risk of isolated CNS relapse (P = 0.0007). Event-free survival was significantly improved with dexamethasone (84.2% vs. 75.6% at 5 years; P = 0.01), with no evidence of differing effects in any subgroup of patients. The use of 6.5 mg/m(2) dexamethasone throughout treatment for ALL led to a significant decrease in the risk of relapse for all risk-groups of patients and, despite the increased toxicity, should now be regarded as part of standard therapy for childhood ALL.
Affiliation:
Paediatric Haematology/Oncology, John Radcliffe Hospital, Oxford, UK. chris.mitchell@paediatrics.ox.ac.uk
Citation:
Benefit of dexamethasone compared with prednisolone for childhood acute lymphoblastic leukaemia: results of the UK Medical Research Council ALL97 randomized trial. 2005, 129 (6):734-45 Br. J. Haematol.
Journal:
British Journal of Haematology
Issue Date:
Jun-2005
URI:
http://hdl.handle.net/10541/74887
DOI:
10.1111/j.1365-2141.2005.05509.x
PubMed ID:
15952999
Type:
Article
Language:
en
ISSN:
0007-1048
Appears in Collections:
All Christie Publications

Full metadata record

DC FieldValue Language
dc.contributor.authorMitchell, Christopher D-
dc.contributor.authorRichards, Susan M-
dc.contributor.authorKinsey, Sally E-
dc.contributor.authorLilleyman, John S-
dc.contributor.authorVora, Ajay J-
dc.contributor.authorEden, Tim O B-
dc.date.accessioned2009-07-22T10:34:38Z-
dc.date.available2009-07-22T10:34:38Z-
dc.date.issued2005-06-
dc.identifier.citationBenefit of dexamethasone compared with prednisolone for childhood acute lymphoblastic leukaemia: results of the UK Medical Research Council ALL97 randomized trial. 2005, 129 (6):734-45 Br. J. Haematol.en
dc.identifier.issn0007-1048-
dc.identifier.pmid15952999-
dc.identifier.doi10.1111/j.1365-2141.2005.05509.x-
dc.identifier.urihttp://hdl.handle.net/10541/74887-
dc.description.abstractCorticosteroids are an essential component of treatment for acute lymphoblastic leukaemia (ALL). Prednisolone is the most commonly used steroid, particularly in the maintenance phase of therapy. There is increasing evidence that, even in equipotent dosage for glucocorticoid effect, dexamethasone has enhanced lymphoblast cytotoxicity and penetration of the central nervous system (CNS) compared with prednisolone. Substitution of dexamethasone for prednisolone in the treatment of ALL might, therefore, result in improved event-free and overall survival. Children with newly diagnosed ALL were randomly assigned to receive either dexamethasone or prednisolone in the induction, consolidation (all received dexamethasone in intensification) and continuation phases of treatment. Among 1603 eligible randomized patients, those receiving dexamethasone had half the risk of isolated CNS relapse (P = 0.0007). Event-free survival was significantly improved with dexamethasone (84.2% vs. 75.6% at 5 years; P = 0.01), with no evidence of differing effects in any subgroup of patients. The use of 6.5 mg/m(2) dexamethasone throughout treatment for ALL led to a significant decrease in the risk of relapse for all risk-groups of patients and, despite the increased toxicity, should now be regarded as part of standard therapy for childhood ALL.en
dc.language.isoenen
dc.subjectLeukaemic Infiltrationen
dc.subject.meshAdolescent-
dc.subject.meshAge Factors-
dc.subject.meshCentral Nervous System-
dc.subject.meshChild-
dc.subject.meshChild, Preschool-
dc.subject.meshDexamethasone-
dc.subject.meshDisease-Free Survival-
dc.subject.meshFemale-
dc.subject.meshGlucocorticoids-
dc.subject.meshHumans-
dc.subject.meshInfant-
dc.subject.meshLeukemic Infiltration-
dc.subject.meshMale-
dc.subject.meshPrecursor Cell Lymphoblastic Leukemia-Lymphoma-
dc.subject.meshPrednisolone-
dc.subject.meshRecurrence-
dc.subject.meshTreatment Outcome-
dc.titleBenefit of dexamethasone compared with prednisolone for childhood acute lymphoblastic leukaemia: results of the UK Medical Research Council ALL97 randomized trial.en
dc.typeArticleen
dc.contributor.departmentPaediatric Haematology/Oncology, John Radcliffe Hospital, Oxford, UK. chris.mitchell@paediatrics.ox.ac.uken
dc.identifier.journalBritish Journal of Haematologyen

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