Lower incidence of meningeal leukemia when prednisone is replaced by dexamethasone in the treatment of acute lymphocytic leukemia
| Autor: | Arvin S. Glicksman, Jurg Sartorius, Louise Chevalier, Hansjuerg Pluess, Barbara Seligman, Faith H. Kung, Arthur Sawitsky, James F. Holland, Farid Haurani, Frederick B. Ruymann, Kjell Koch, Oliver Glidewell, Edwin N. Forman, Jonathan J. Shuster, Barbara Jones, Marise Weil, Claude Jacquillat, Marie J. Stuart, Geoffrey Falkson, Carl Pochedly, Arnold I. Freeman, John T. Truman, Harold M. Maurer, Richard B. Patterson, Nasrollah Hakami, E. Omer Burgert, Lucius F. Sinks |
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| Rok vydání: | 1991 |
| Předmět: |
Cancer Research
medicine.medical_specialty Adolescent medicine.drug_class medicine.medical_treatment Gastroenterology Dexamethasone Random Allocation Recurrence Prednisone Internal medicine Acute lymphocytic leukemia Antineoplastic Combined Chemotherapy Protocols Remission Induction Therapy Meningeal Neoplasms medicine Humans Child Chemotherapy Leukemia business.industry Incidence Remission Induction Radiotherapy Dosage Precursor Cell Lymphoblastic Leukemia-Lymphoma medicine.disease Combined Modality Therapy Surgery Oncology Pediatrics Perinatology and Child Health Corticosteroid business Meningeal Leukemia medicine.drug |
| Zdroj: | Medical and Pediatric Oncology. 19:269-275 |
| ISSN: | 1096-911X 0098-1532 |
| DOI: | 10.1002/mpo.2950190411 |
| Popis: | In 1971, Cancer and Leukemia Group B (CALGB) mounted a study of acute lymphocytic leukemia (ALL) that compared the effects of the two steroid hormones dexamethasone and prednisone. Six-hundred-forty-six children and adolescents with ALL were randomized to receive either prednisone or dexamethasone as part of their remission induction therapy. The 493 evaluable patients who achieved complete remission received the same steroid as pulses throughout remission. Specific central nervous system (CNS) therapy was randomized to either six injections of intrathecal methotrexate (IT MTX) alone or to six injections of IT MTX with cranial radiation (2,400 cGy). Both cranial radiation and dexamethasone offered increased protection against CNS relapse as the first site of failure over IT MTX alone. There were 30 CNS relapses among 238 patients (12.6%) receiving cranial radiation plus IT MTX, whereas there were 70 CNS relapses among 225 (P less than 0.001) (22.5%) in those who received IT MTX alone. Similarly, there were 33 CNS relapses among 231 (14.3%) children treated with dexamethasone, whereas there were 67 CNS relapses among 262 (25.6%) treated with prednisone (P = 0.017). Both steroids appeared equal in protecting the bone marrow. Recent national studies have shown significant improvements in preventing CNS relapse over the results in the present report. However, this finding warrants further investigation and, with further documentation, could lead to the substitution of prednisone by dexamethasone to aid further in preventing CNS relapse. This may be particularly important in patients at higher risk for CNS relapse. |
| Databáze: | OpenAIRE |
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