Lower incidence of meningeal leukemia when prednisone is replaced by dexamethasone in the treatment of acute lymphocytic leukemia

Barbara Jones, Arnold I. Freeman, Jonathan J. Shuster, Claude Jacquillat, Marise Weil, Carl Pochedly, Lucius Sinks, Louise Chevalier, Harold Maurice Maurer, Kjell Koch, Geoffrey Falkson, Richard Patterson, Barbara Seligman, Jurg Sartorius, Faith Kung, Farid Haurani, Marie Stuart, E. Omer Burgert, Frederick Ruymann, Arthur Sawitsky & 7 others Edwin Forman, Hansjuerg Pluess, John Truman, Nasrollah Hakami, Oliver Glidewell, Arvin S. Glicksman, James F. Holland

Research output: Contribution to journalArticle

117 Citations (Scopus)

Abstract

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 dexa‐methasome 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 < 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.

Original languageEnglish (US)
Pages (from-to)269-275
Number of pages7
JournalMedical and Pediatric Oncology
Volume19
Issue number4
DOIs
StatePublished - Jan 1 1991

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Prednisone
Precursor Cell Lymphoblastic Leukemia-Lymphoma
Dexamethasone
Leukemia
Central Nervous System
Recurrence
Incidence
Methotrexate
Spinal Injections
Therapeutics
Steroids
Radiation
Remission Induction
Documentation
Bone Marrow
Hormones

Keywords

  • CNS leukemia
  • Cancer and Leukemia Group B
  • steroid therapy

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Oncology
  • Cancer Research

Cite this

Lower incidence of meningeal leukemia when prednisone is replaced by dexamethasone in the treatment of acute lymphocytic leukemia. / Jones, Barbara; Freeman, Arnold I.; Shuster, Jonathan J.; Jacquillat, Claude; Weil, Marise; Pochedly, Carl; Sinks, Lucius; Chevalier, Louise; Maurer, Harold Maurice; Koch, Kjell; Falkson, Geoffrey; Patterson, Richard; Seligman, Barbara; Sartorius, Jurg; Kung, Faith; Haurani, Farid; Stuart, Marie; Burgert, E. Omer; Ruymann, Frederick; Sawitsky, Arthur; Forman, Edwin; Pluess, Hansjuerg; Truman, John; Hakami, Nasrollah; Glidewell, Oliver; Glicksman, Arvin S.; Holland, James F.

In: Medical and Pediatric Oncology, Vol. 19, No. 4, 01.01.1991, p. 269-275.

Research output: Contribution to journalArticle

Jones, B, Freeman, AI, Shuster, JJ, Jacquillat, C, Weil, M, Pochedly, C, Sinks, L, Chevalier, L, Maurer, HM, Koch, K, Falkson, G, Patterson, R, Seligman, B, Sartorius, J, Kung, F, Haurani, F, Stuart, M, Burgert, EO, Ruymann, F, Sawitsky, A, Forman, E, Pluess, H, Truman, J, Hakami, N, Glidewell, O, Glicksman, AS & Holland, JF 1991, 'Lower incidence of meningeal leukemia when prednisone is replaced by dexamethasone in the treatment of acute lymphocytic leukemia', Medical and Pediatric Oncology, vol. 19, no. 4, pp. 269-275. https://doi.org/10.1002/mpo.2950190411
Jones, Barbara ; Freeman, Arnold I. ; Shuster, Jonathan J. ; Jacquillat, Claude ; Weil, Marise ; Pochedly, Carl ; Sinks, Lucius ; Chevalier, Louise ; Maurer, Harold Maurice ; Koch, Kjell ; Falkson, Geoffrey ; Patterson, Richard ; Seligman, Barbara ; Sartorius, Jurg ; Kung, Faith ; Haurani, Farid ; Stuart, Marie ; Burgert, E. Omer ; Ruymann, Frederick ; Sawitsky, Arthur ; Forman, Edwin ; Pluess, Hansjuerg ; Truman, John ; Hakami, Nasrollah ; Glidewell, Oliver ; Glicksman, Arvin S. ; Holland, James F. / Lower incidence of meningeal leukemia when prednisone is replaced by dexamethasone in the treatment of acute lymphocytic leukemia. In: Medical and Pediatric Oncology. 1991 ; Vol. 19, No. 4. pp. 269-275.
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