Potential Benefits of Prednisolone Administration Compared to Dexamethasone During Remission Induction Treatment for Childhood Acute Lymphoblastic Leukemia

Kim, Min Sung; Kim, Myoung Hyun; Lee, Jae Wook; Jang, Pil Sang; Chung, Nak Gyun; Cho, Bin; Jeong, Dae Chul; Kim, Hack Ki

Abstract

PURPOSE
Due to its high potency against leukemic blasts, our institution previously used dexamethasone during acute lymphoblastic leukemia (ALL) remission induction, but in our most recent treatment protocol, CMCPL-2009, we changed to prednisolone for steroid therapy. We compared both the rates of remission induction and significant complications observed during induction with CMCPL-2009, with those noted for our previous protocol, CMCPL-2005.
METHODS
We retrospectively reviewed the records of patients diagnosed with ALL from January 2005 to December 2008 at the Department of Pediatrics, St. Mary's Hospital, the Catholic University of Korea. Data concerning age, sex, WBC count at diagnosis, immunophenotype and overall risk group were collected for each patient. Results of remission induction treatment were compared between the two patient groups. Infection and other major complications resulting from treatment were investigated according to NCI toxicity criteria.
RESULTS
A total of 163 and 53 patients received remission induction under CMCPL-2005 and CMCPL-2009, respectively. In the CMCPL-2005 group, 152 (93.3%) achieved complete remission while 53 (100%) achieved CR in the CMCPL-2009 group. Patients in the CMCPL-2009 group had a significantly lower rate of major complications than those in the CMCPL-2005 group (P=0.004), including infectious complications.
CONCLUSION
We changed dexamethasone to prednisolone for steroid treatment, yet found the remission induction rate to be comparable to that of our previous regimen. Rates of major complications including infection decreased significantly.