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

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    Authors
    Mitchell, Christopher D
    Richards, Susan M
    Kinsey, Sally E
    Lilleyman, John S
    Vora, Ajay J
    Eden, Tim O B
    Affiliation
    Paediatric Haematology/Oncology, John Radcliffe Hospital, Oxford, UK. chris.mitchell@paediatrics.ox.ac.uk
    Issue Date
    2005-06
    
    Metadata
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    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.
    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
    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
    ae974a485f413a2113503eed53cd6c53
    10.1111/j.1365-2141.2005.05509.x
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