title: [Steroid intake before leukemia diagnosis impairs outcome in childhood acute lymphoblastic leukemia].
abstract: The aim of this study was to show that steroid therapy taken before the diagnosis of acute lymphoblastic leukemia (ALL) can alter the management of the disease.
  
  
  METHODS
  We conducted a multicenter retrospective study on 11 children treated between 2005 and 2011, who received oral steroids ranging from 0.6 to 3.3mg/kg/day prednisolone equivalent for a duration of 2 to 15 days during the 2 months prior to diagnosis of ALL.
  
  
  RESULTS
  Four children had febrile pancytopenia. Among them, 2 had severe infections and a noncontributive bone marrow aspiration. One of them presented a severe tumoral lysis syndrome and was hospitalized twice in the intensive care unit. Two teenagers had central nervous system involvement at diagnosis of T-ALL, 1 having associated cutaneous locations, the second one showing pulmonary and central nervous system (CNS) leukostasis with renal failure and disseminated intravascular coagulation. One child died of septic shock during the induction phase of steroid-resistant T-ALL. Four children had no complications during the induction phase. Steroid resistance occurred in 5 cases and steroid sensitivity could not be evaluated in 3 cases. Three allogeneic bone marrow transplants were performed: the first one because of early CNS relapse, the 2 others because of initial treatment resistance.
  
  
  CONCLUSIONS
  Steroids can induce a delay in the management of ALL and seem to favor initial complications, and possibly increase diffuse locations as well as steroid resistance. Their prescription needs to be carefully managed, especially for uncharacteristic infectious symptoms. Then a complete blood count should be done.
authors: Service d'immuno-hématologie pédiatrique, CHU de Rouen, 1, rue de Germont, 76000 Rouen, France. sophiegs@orange.fr
authors: S
authors: S
authors: Gatineau-Sailliant
authors: N
authors: N
authors: Buchbinder
authors: M P
authors: MP
authors: Callat
authors: B
authors: B
authors: Nelken
authors: B
authors: B
authors: Pautard
authors: J-P
authors: JP
authors: Vannier
authors: P
authors: P
authors: Schneider
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D005938:Glucocorticoids / Q000009:adverse effects* / Q000627:therapeutic use; D006801:Humans; D007223:Infant; D008297:Male; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000150:complications / Q000175:diagnosis* / Q000628:therapy; D011239:Prednisolone / Q000009:adverse effects* / Q000627:therapeutic use; D012189:Retrospective Studies
chemical_list: D005938:Glucocorticoids; D011239:Prednisolone