title: [Clinical significance of glucocorticoid induction test in Chinese childhood acute lymphoblastic leukemia].
abstract: OBJECTIVE
  Acute lymphoblastic leukemia (ALL) is the most common childhood cancer, while glucocorticoid (GC) is a critical component in multi-agent chemotherapy protocols currently used for the treatment of ALL. The purpose of this study was to investigate the relationship between the glucocorticoid induction test and the clinical features and the prognosis of Chinese childhood ALL.
  
  
  METHODS
  The study recruited 309 hospitalized patients (187 male and 122 female) with childhood ALL, the sex, age, initial WBC count, immunophenotype, chromosome and gene expression were recorded. After diagnosis, all patients received GC induction test for 7 days. Then they were divided into prednisone good response (PGR) group and prednisone poor response (PPR) group according to the peripheral lymphoblast count on D8. Early responses to chemotherapy and treatment outcomes of the patients in the two groups were also analyzed.
  
  
  RESULTS
  Of the 309 patients, 263 belonged to PGR group and 46 belonged to PPR group. Initial WBC count was higher in PPR group than in PGR group (86.30×10(9)/L vs. 30.97×10(9)/L, P < 0.01) . B lineage ALL showed more sensitive to GC than T-ALL (86.6% vs. 60%, P < 0.05). Different initial-risk-group's sensitivity to GC differed from one another (high-risk:51.4%, medium-risk: 82.7%, standard risk: 93.7%, P < 0.0125). There was no significant difference between two groups in chromosomal karyotypes (P > 0.05). BCR-ABL positive ALL showed lower sensitivity to GC (P < 0.05) , while MLL, TEL-AML1, E2A-PBX1 positive rates in two groups were of no statistical significance (P > 0.05). Bone marrow was reviewed on D15 and D33, and the CR rates in PGR group were significantly higher than that in PPR group (D15: 60.5% vs. 32.6%, D33: 94.6% vs. 73.3%, P < 0.01) ; Minimal residual disease (MRD) levels were examined on D33, W12, and both were much lower in PGR group (D33: P < 0.01, W12: P < 0.05). Of the PGR group 215 patients (81.7%) remained continuously in complete remission (CCR) while only 28 cases (60.9%) in PPR group did so. The CCR rate was much higher in PGR group than that in PPR group (P < 0.01).
  
  
  CONCLUSIONS
  Closely related to clinical features and the outcomes of treatment, GC induction test is also an important prognostic factor in Chinese childhood ALL.
authors.affiliation: Department of Hematology and Oncology, Soochow University Affiliated Children's Hospital, Suzhou 215003, China.
authors.forename: Jun-jie
authors.initials: JJ
authors.lastname: Fan
authors.forename: Yi-huan
authors.initials: YH
authors.lastname: Chai
authors.forename: Shao-yan
authors.initials: SY
authors.lastname: Hu
authors.forename: Hai-long
authors.initials: HL
authors.lastname: He
authors.forename: Wen-li
authors.initials: WL
authors.lastname: Zhao
authors.forename: Yi
authors.initials: Y
authors.lastname: Wang
authors.forename: Jie
authors.initials: J
authors.lastname: Li
authors.forename: Jun
authors.initials: J
authors.lastname: Lu
authors.forename: Pei-fang
authors.initials: PF
authors.lastname: Xiao
authors.forename: Yi-na
authors.initials: YN
authors.lastname: Sun
authors.forename: Wei
authors.initials: W
authors.lastname: Wang
authors.forename: Lan
authors.initials: L
authors.lastname: Cao
mesh_terms: D000293:Adolescent; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D014408:Biomarkers, Tumor; D002648:Child; D002675:Child, Preschool; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D007223:Infant; D007958:Leukocyte Count; D008297:Male; D018365:Neoplasm, Residual / Q000188:drug therapy / Q000235:genetics; D015514:Oncogene Proteins, Fusion / Q000235:genetics; D016133:Polymerase Chain Reaction; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000175:diagnosis / Q000188:drug therapy* / Q000235:genetics / Q000401:mortality; D011237:Predictive Value of Tests; D011379:Prognosis; D012074:Remission Induction; D015996:Survival Rate
chemical_list: D014408:Biomarkers, Tumor; D005938:Glucocorticoids; D015514:Oncogene Proteins, Fusion