[Prognostic value of the initial response to corticosteroids for children with acute lymphoblastic leukemia].
Leukemias are the most common malignant diseases in childhood, with acute lymphoblastic leukemia (ALL) being the most frequent subtype. Diagnosis and treatment of ALL remains an important issue in pediatric practice. The great variety of prognostic factors has been recognized and applied for the stratification into different risk groups and consequently for selection of the most appropriate treatment. The most significant prognostic factors include age, sex, white blood count at diagnosis, infiltration of the extramedullary organs, and central nervous system involvement. The experience of numerous pediatric hemato-oncology centers has shown that above-mentioned prognostic criteria are not sufficient and they emphasize the need for determination of the response to glucocorticosteroids at day 8 of treatment. A retrospective analysis of treatment results in childhood in ALL patients with regard to steroid response has been performed. The study aimed at analysis whether there is any association between the long-term event-free survival (EFS) in patients with good and poor response to prednisone. The study group consisted of 179 children, aged 2 to 17 years, qualified into low and medium risk groups, treated according to the BFM-86 and BFM-90 protocols in the Department of Pediatrics and Hematology of Silesian Center of Pediatrics in Zabrze between 1986 and 1996. In the study group, 89.9% (161) of children showed good prednisone response (PGR) as compared to 10.1% of children with poor response to steroids (PPR). Cumulative probability of 15-year EFS for the PGR group was 70% and significantly differed from EFS in PPR group (39%; p = 0.006). In the study group, the children showing good response to the initial treatment with prednisone have higher chance for durable remission and subsequent cure. In conclusion, response to glucocorticosteroids employed in the initial treatment of children with ALL, should be included in the stratification into prognostic groups.
Klimza
Małgorzata J
MJ
Studium Doktoranckiego Wydziału Lekarskiego w Zabrzu.
Sońta-Jakimczyk
Danuta J
DJ
D000293:Adolescent; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D018450:Disease Progression; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008297:Male; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality; D011237:Predictive Value of Tests; D011241:Prednisone / Q000627:therapeutic use*; D011379:Prognosis; D012307:Risk Factors
D000893:Anti-Inflammatory Agents; D011241:Prednisone