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Benefit of high-dose methylprednisolone in comparison with conventional-dose prednisolone during remission induction therapy in childhood acute lymphoblastic leukemia for long-term follow-up

Leukemia volume 17, pages 328–333 (2003)Cite this article

Abstract

Eight-year event-free survival (EFS) was evaluated in 205 patients with acute lymphoblastic leukemia (ALL), to consider the efficacy of high-dose methylprednisolone (HDMP) given during remission induction chemotherapy between 1 and 29 days. The St Jude Total XI Study protocol was used after some minor modifications in this trial. Patients were randomized into two groups. Group A (n = 108) received conventional dose (60 mg/m2/day orally) prednisolone and group B (n = 97) received HDMP (Prednol-L, 900–600 mg/m2 orally) during remission induction chemotherapy. Complete remission was obtained in 95% of the 205 patients who were followed-up for 11 years; median follow-up was 72 months (range 60–129) and 8-year EFS rate was 60% overall (53% in group A, 66% in group B). The EFS rate of group B was significantly higher than of group A (P = 0.05). The 8-year EFS rate of groups A and B in the high-risk groups was 39% vs 63% (P = 0.002). When we compared 8-year EFS rate in groups A and B in the high-risk subgroup for both ages together ⩽2 or ⩾10 years, it was 44% vs 74%, respectively. Among patients in the high-risk subgroup with a WBC count ⩾50 × 109/l, the 8-year EFS was 38% in group A vs58% in group B. During the 11-year follow-up period, a total of 64 relapses occurred in 205 patients. In group A relapses were higher (39%) than in group B (23%) (P = 0.05). These results suggest that HDMP during remission-induction chemotherapy improves the EFS rate significantly for high-risk patients in terms of the chances of cure.

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Acknowledgements

The authors would like to thank Selma Sar, Gürsel Söylemezoglu and Zeynep Saraç for their valuable technical assistance and our nurses Miss Fatma Savas and Miss Müzeyyen Tetik for their generous and enthusiastic help to the patients.

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Authors and Affiliations

  1. Department of Pediatric Hematology, Hacettepe University, Ihsan Dogramaci Children’s Hospital, Ankara, Turkey

    S Yetgin, M A Tuncer, M Çetin, F Gümrük, I Yenicesu, B Tunç, A F Öner, H Toksoy, A Koç, D Aslan, E Özyürek, L Olcay & A Gürgey

  2. Department of Radiation Oncology, Hacettepe University, Ankara, Turkey

    L Atahan & E Tunçbilek

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  1. S Yetgin
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Department of Genetics, Hacettepe University, Ihsan Dogramaci Children’s Hospital, Ankara, Turkey

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Yetgin, S., Tuncer, M., Çetin, M. et al. Benefit of high-dose methylprednisolone in comparison with conventional-dose prednisolone during remission induction therapy in childhood acute lymphoblastic leukemia for long-term follow-up. Leukemia 17, 328–333 (2003). https://doi.org/10.1038/sj.leu.2402673

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