SEARCH:   Advanced

Prepublished online as a Blood First Edition Paper on January 16, 2003; DOI 10.1182/blood-2002-08-2454. This Article Full Text (PDF) All Versions of this Article: 2002-08-2454v1 101/10/3809    most recent Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Rights and Permissions Citing Articles Citing Articles via HighWire Citing Articles via CrossRef Citing Articles via Google Scholar Google Scholar Articles by Bostrom, B. C Articles by Trigg, M. E Search for Related Content PubMed PubMed Citation Articles by Bostrom, B. C Articles by Trigg, M. E Social Bookmarking                   What's this? Submitted August 12, 2002 Accepted December 15, 2002 Dexamethasone versus prednisone and daily oral versus weekly intravenous mercaptopurine for patients with standard-risk acute lymphoblastic leukemia: a report from the Children's Cancer Group Bruce C Bostrom*, Martha R Sensel, Harland N Sather, Paul Gaynon, Mei K La, Katherine Johnston, Gary R Erdmann, Stuart Gold, Nyla A Heerema, Raymond J Hutchinson, Arthur J Provisor, and Michael E Trigg Department of Pediatric Oncology, Children's Hospitals and Clinics, Minneapolis, MN, USA Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA Children's Oncology Group, Arcadia, CA, USA Department of Pediatric Oncology, Childrens Hospital Los Angeles, Los Angeles, CA, USA Department of Pediatric Oncology, Childrens Hospital of Columbus, Columbus, OH, USA PRACS Inst. Ltd., Fargo, ND, USA University of North Carolina, Chapel Hill, NC, USA C.S. Mott Children's Hospital, Ann Arbor, MI, USA Columbus Regional Medical Center, Columbus, GA, USA Christiana Care Healthh Services, Wilmington, DE, USA * Corresponding author; email: bostrom{at}childrenshc.org. Background: Conventional therapy for childhood acute lymphoblastic leukemia (ALL) includes prednisone and oral 6-mercaptopurine. Prior observations suggested potential advantages for dexamethasone over prednisone and for intravenous (IV) over oral 6-mercaptopurine, which remain to be validated. We report the results of a randomized trial of more than 1000 subjects that examined the efficacy of dexamethasone and IV 6-mercaptopurine. Methods: Children with NCI standard-risk ALL were randomly assigned in a 2 x 2 factorial design to receive dexamethasone (6 mg/m2/day) for 28 days in induction, plus taper, compared with prednisone (40 mg/m2/day). The second randomized assignment was for daily oral or weekly IV 6-mercaptopurine during consolidation. During maintenance, 5 days of the randomized steroid was given monthly, at the same dose and all patients received daily oral 6-mercaptopurine. During delayed intensification, all patients received a dexamethasone dosage of 10 mg/m2/day for 21 days, with taper. Intrathecal (IT) methotrexate was the sole central-nervous-system-directed therapy. Results: Patients randomly assigned to receive dexamethasone had a 6-year isolated central-nervous-system relapse rate of 3.7 ± 0.8%, compared with 7.1 ± 1.1% for prednisone (p = 0.01). There was also a trend toward fewer isolated bone marrow relapses with dexamethasone. The 6-year event-free survival (EFS) was 85 ± 2% for dexamethasone and 77 ± 2% for prednisone (p = 0.002). EFS was similar with oral or IV 6-mercaptopurine; however, patients assigned to IV 6-mercaptopurine had decreased survival after relapse. Conclusions: Dexamethasone but not intravenous 6-mercaptopurine improved outcomes in children with ALL. CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this? This article has been cited by other articles: N. S. Kadan-Lottick, P. Brouwers, D. Breiger, T. Kaleita, J. Dziura, H. Liu, L. Chen, M. Nicoletti, L. Stork, B. Bostrom, et al. A comparison of neurocognitive functioning in children previously randomized to dexamethasone or prednisone in the treatment of childhood acute lymphoblastic leukemia Blood, August 27, 2009; 114(9): 1746 - 1752. [Abstract] [Full Text] [PDF] M. N. Sitaresmi, S. Mostert, I. Purwanto, C. M. Gundy, Sutaryo, and A. J. P. Veerman Chemotherapy-Related Side Effects in Childhood Acute Lymphoblastic Leukemia in Indonesia: Parental Perceptions Journal of Pediatric Oncology Nursing, July 1, 2009; 26(4): 198 - 207. [Abstract] [PDF] C.-H. Pui, D. Campana, D. Pei, W. P. Bowman, J. T. Sandlund, S. C. Kaste, R. C. Ribeiro, J. E. Rubnitz, S. C. Raimondi, M. Onciu, et al. Treating Childhood Acute Lymphoblastic Leukemia without Cranial Irradiation N. Engl. J. Med., June 25, 2009; 360(26): 2730 - 2741. [Abstract] [Full Text] [PDF] W. Stock, M. La, B. Sanford, C. D. Bloomfield, J. W. Vardiman, P. Gaynon, R. A. Larson, and J. Nachman What determines the outcomes for adolescents and young adults with acute lymphoblastic leukemia treated on cooperative group protocols? A comparison of Children's Cancer Group and Cancer and Leukemia Group B studies Blood, September 1, 2008; 112(5): 1646 - 1654. [Abstract] [Full Text] [PDF] F. Tucci and M. Arico Treatment of pediatric acute lymphoblastic leukemia Haematologica, August 1, 2008; 93(8): 1124 - 1128. [Full Text] [PDF] N. S. Kadan-Lottick, I. Dinu, K. Wasilewski-Masker, S. Kaste, L. R. Meacham, A. Mahajan, M. Stovall, Y. Yasui, L. L. Robison, and C. A. Sklar Osteonecrosis in Adult Survivors of Childhood Cancer: A Report From the Childhood Cancer Survivor Study J. Clin. Oncol., June 20, 2008; 26(18): 3038 - 3045. [Abstract] [Full Text] [PDF] D. French, L. H. Hamilton, L. A. Mattano Jr, H. N. Sather, M. Devidas, J. B. Nachman, and M. V. Relling A PAI-1 (SERPINE1) polymorphism predicts osteonecrosis in children with acute lymphoblastic leukemia: a report from the Children's Oncology Group Blood, May 1, 2008; 111(9): 4496 - 4499. [Abstract] [Full Text] [PDF] A. Moricke, A. Reiter, M. Zimmermann, H. Gadner, M. Stanulla, M. Dordelmann, L. Loning, R. Beier, W.-D. Ludwig, R. Ratei, et al. Risk-adjusted therapy of acute lymphoblastic leukemia can decrease treatment burden and improve survival: treatment results of 2169 unselected pediatric and adolescent patients enrolled in the trial ALL-BFM 95 Blood, May 1, 2008; 111(9): 4477 - 4489. [Abstract] [Full Text] [PDF] S. D. Sanford, J. O. Okuma, J. Pan, D. K. Srivastava, N. West, L. Farr, and P. S. Hinds Gender Differences in Sleep, Fatigue, and Daytime Activity in a Pediatric Oncology Sample Receiving Dexamethasone J. Pediatr. Psychol., April 1, 2008; 33(3): 298 - 306. [Abstract] [Full Text] [PDF] N. L. Seibel Treatment of Acute Lymphoblastic Leukemia in Children and Adolescents: Peaks and Pitfalls Hematology, January 1, 2008; 2008(1): 374 - 380. [Abstract] [Full Text] [PDF] M. V. Relling, W. E. Evans, and C.-H. Pui Continue to study childhood ALL Blood, January 1, 2008; 111(1): 468 - 469. [Full Text] [PDF] S. Malempati, P. S. Gaynon, H. Sather, M. K. La, and L. C. Stork Outcome After Relapse Among Children With Standard-Risk Acute Lymphoblastic Leukemia: Children's Oncology Group Study CCG-1952 J. Clin. Oncol., December 20, 2007; 25(36): 5800 - 5807. [Abstract] [Full Text] [PDF] R. Felder-Puig, C. Scherzer, M. Baumgartner, M. Ortner, C. Aschenbrenner, C. Bieglmayer, T. Voigtlander, E. R. Panzer-Grumayer, W. J.E. Tissing, J. W. Koper, et al. Glucocorticoids in the Treatment of Children with Acute Lymphoblastic Leukemia and Hodgkin's Disease: A Pilot Study on the Adverse Psychological Reactions and Possible Associations with Neurobiological, Endocrine, and Genetic Markers Clin. Cancer Res., December 1, 2007; 13(23): 7093 - 7100. [Abstract] [Full Text] [PDF] J. M. Rowe and A. H. Goldstone How I treat acute lymphocytic leukemia in adults Blood, October 1, 2007; 110(7): 2268 - 2275. [Abstract] [Full Text] [PDF] J. Feusner "Lesser" ALL: treat less or study less? Blood, August 15, 2007; 110(4): 1086 - 1086. [Full Text] [PDF] A. R. Chauvenet, P. L. Martin, M. Devidas, S. B. Linda, B. A. Bell, J. Kurtzberg, J. Pullen, M. J. Pettenati, A. J. Carroll, J. J. Shuster, et al. Antimetabolite therapy for lesser-risk B-lineage acute lymphoblastic leukemia of childhood: a report from Children's Oncology Group Study P9201 Blood, August 15, 2007; 110(4): 1105 - 1111. [Abstract] [Full Text] [PDF] A. M. Butturini, F. J. Dorey, B. J. Lange, D. W. Henry, P. S. Gaynon, C. Fu, J. Franklin, S. E. Siegel, N. L. Seibel, P. C. Rogers, et al. Obesity and Outcome in Pediatric Acute Lymphoblastic Leukemia J. Clin. Oncol., May 20, 2007; 25(15): 2063 - 2069. [Abstract] [Full Text] [PDF] R. A. Niinimaki, A. H. Harila-Saari, A. E. Jartti, R. M. Seuri, P. V. Riikonen, E. L. Paakko, M. I. Mottonen, and M. Lanning High Body Mass Index Increases the Risk for Osteonecrosis in Children With Acute Lymphoblastic Leukemia J. Clin. Oncol., April 20, 2007; 25(12): 1498 - 1504. [Abstract] [Full Text] [PDF] E. J. Karimova, S. N. Rai, S. C. Howard, M. Neel, L. Britton, C.-H. Pui, and S. C. Kaste Femoral Head Osteonecrosis in Pediatric and Young Adult Patients With Leukemia or Lymphoma J. Clin. Oncol., April 20, 2007; 25(12): 1525 - 1531. [Abstract] [Full Text] [PDF] K. R. Schultz, D. J. Pullen, H. N. Sather, J. J. Shuster, M. Devidas, M. J. Borowitz, A. J. Carroll, N. A. Heerema, J. E. Rubnitz, M. L. Loh, et al. Risk- and response-based classification of childhood B-precursor acute lymphoblastic leukemia: a combined analysis of prognostic markers from the Pediatric Oncology Group (POG) and Children's Cancer Group (CCG) Blood, February 1, 2007; 109(3): 926 - 935. [Abstract] [Full Text] [PDF] W. Stock and N. L. Seibel Acute lymphoblastic leukemia and lymphoblastic lymphoma ASH Self-Assessment Program, January 1, 2007; 2007(1): 253 - 264. [Full Text] [PDF] Y. Matloub, S. Lindemulder, P. S. Gaynon, H. Sather, M. La, E. Broxson, R. Yanofsky, R. Hutchinson, N. A. Heerema, J. Nachman, et al. Intrathecal triple therapy decreases central nervous system relapse but fails to improve event-free survival when compared with intrathecal methotrexate: results of the Children's Cancer Group (CCG) 1952 study for standard-risk acute lymphoblastic leukemia, reported by the Children's Oncology Group Blood, August 15, 2006; 108(4): 1165 - 1173. [Abstract] [Full Text] [PDF] E. J. Karimova, S. N. Rai, X. Deng, D. J. Ingle, A. C. Ralph, M. D. Neel, and S. C. Kaste MRI of Knee Osteonecrosis in Children with Leukemia and Lymphoma: Part 1, Observer Agreement Am. J. Roentgenol., February 1, 2006; 186(2): 470 - 476. [Abstract] [Full Text] [PDF] C.-H. Pui and W. E. Evans Treatment of Acute Lymphoblastic Leukemia N. Engl. J. Med., January 12, 2006; 354(2): 166 - 178. [Full Text] [PDF] A. J Murphy, J. C. Wells, J. E Williams, M. S Fewtrell, P. S. Davies, and D. K Webb Body composition in children in remission from acute lymphoblastic leukemia Am. J. Clinical Nutrition, January 1, 2006; 83(1): 70 - 74. [Abstract] [Full Text] [PDF] C.-H. Pui Central Nervous System Disease in Acute Lymphoblastic Leukemia: Prophylaxis and Treatment Hematology, January 1, 2006; 2006(1): 142 - 146. [Abstract] [Full Text] [PDF] E. J. Jabbour, S. Faderl, and H. M. Kantarjian Adult Acute Lymphoblastic Leukemia Mayo Clin. Proc., November 1, 2005; 80(11): 1517 - 1527. [Abstract] [PDF] S. Igarashi, A. Manabe, A. Ohara, M. Kumagai, T. Saito, Y. Okimoto, T. Kamijo, K. Isoyama, M. Kajiwara, M. Sotomatsu, et al. No Advantage of Dexamethasone Over Prednisolone for the Outcome of Standard- and Intermediate-Risk Childhood Acute Lymphoblastic Leukemia in the Tokyo Children's Cancer Study Group L95-14 Protocol J. Clin. Oncol., September 20, 2005; 23(27): 6489 - 6498. [Abstract] [Full Text] [PDF] S. R. Pine, C. Yin, Y. H. Matloub, H. E. Sabaawy, C. Sandoval, O. Levendoglu-Tugal, M. F. Ozkaynak, and S. Jayabose Detection of Central Nervous System Leukemia in Children with Acute Lymphoblastic Leukemia by Real-Time Polymerase Chain Reaction J. Mol. Diagn., February 1, 2005; 7(1): 127 - 132. [Abstract] [Full Text] [PDF] D. J. DeAngelo The Treatment of Adolescents and Young Adults with Acute Lymphoblastic Leukemia Hematology, January 1, 2005; 2005(1): 123 - 130. [Abstract] [Full Text] [PDF] C.-H. Pui, J. T. Sandlund, D. Pei, D. Campana, G. K. Rivera, R. C. Ribeiro, J. E. Rubnitz, B. I. Razzouk, S. C. Howard, M. M. Hudson, et al. Improved outcome for children with acute lymphoblastic leukemia: results of Total Therapy Study XIIIB at St Jude Children's Research Hospital Blood, November 1, 2004; 104(9): 2690 - 2696. [Abstract] [Full Text] [PDF] M. V. Relling, W. Yang, S. Das, E. H. Cook, G. L. Rosner, M. Neel, S. Howard, R. Ribeiro, J. T. Sandlund, C.-H. Pui, et al. Pharmacogenetic Risk Factors for Osteonecrosis of the Hip Among Children With Leukemia J. Clin. Oncol., October 1, 2004; 22(19): 3930 - 3936. [Abstract] [Full Text] [PDF] D. S. Hawkins, J. R. Park, B. G. Thomson, J. L. Felgenhauer, J. S. Holcenberg, E. H. Panosyan, and V. I. Avramis Asparaginase Pharmacokinetics After Intensive Polyethylene Glycol-Conjugated L-Asparaginase Therapy for Children with Relapsed Acute Lymphoblastic Leukemia Clin. Cancer Res., August 15, 2004; 10(16): 5335 - 5341. [Abstract] [Full Text] [PDF] C.-H. Pui, M. Schrappe, R. C. Ribeiro, and C. M. Niemeyer Childhood and Adolescent Lymphoid and Myeloid Leukemia Hematology, January 1, 2004; 2004(1): 118 - 145. [Abstract] [Full Text] [PDF]

	Copyright © 2003 by American Society of Hematology         Online ISSN: 1528-0020