Benefit of high-dose methylprednisolone in comparison with conventional-dose prednisolone during remission induction therapy in childhood acute lymphoblastic leukemia for long-term follow-up

Yetgin, Sevgi; Tuncer, Murat; Çetin, Mualla; Gümrük, Fatma; Yenicesu, İdil; Tunç, Bahattin; Öner, Ahmet Faik; Toksoy, Hayri B.; Köç, Ahmet; Aslan, Deniz; Ozyurek, Emel; Olcay, Lale; Atahan, Lale; Tunçbılek, Ergül; Gürgey, Aytemiz

doi:10.1038/sj.leu.2402673

Cited by 29 publications

(27 citation statements)

References 30 publications

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“…Diagnosis of ALL and risk criteria of relapse were made according to standard hematological findings [10][11][12]. Chemotherapy had been given according to the modified St. Jude Total XI and Total XIII protocols in 74 and 42 patients, respectively [10,11] (Table I).…”

Section: Methodsmentioning

confidence: 99%

Evaluation of kidney damage in patients with acute lymphoblastic leukemia in long‐term follow‐up: Value of renal scan

Yetgin

Olgar

Aras³

et al. 2004

American J Hematol

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In order to evaluate potential long-term kidney damage of childhood leukemia and risk factors affecting renal damage, we studied 116 children treated for acute lymphoblastic leukemia (ALL) using the St. Jude Total XI and XIII protocols in 1991-1998. The median follow-up period after the completion of treatment was 35 months. The following parameters were examined: urinalysis, urinary creatinine (Cr), calcium (Ca), phosphorus, b 2 -microglobulin, glomerular filtration rate (GFR), tubular phosphorus reabsorption (TPR), and renal function tests. Radiological evaluation included renal ultrasonography (US), and renal scans with DMSA or MAG-3 were performed. Blood chemistry and renal US patients were normal in all patients except two. GFR, TPR, urinary Ca/Cr, b 2 -microglobulin, and renal scan were abnormal in 19.0%, 16.4%, 13.8%, 6.0%, and 40.5% of patients, respectively. The abnormality rate in GFR was significantly higher in patients<2 years of age. TPR abnormality was found to be significantly higher in patients who did not have G-CSF. An abnormal renal scan was associated with Hb< 10 g/dL, kidney infiltration, or hypertension at presentation and also occurred patients who underwent methotrexate treatment with frequent intervals during the follow-up period. Patients should be followed-up after cessation of therapy with the conventional tests mentioned above. In case of any abnormality, further detailed tests should be performed; renal scan seems to be more predictive for renal damage. Am.

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Section: Methodsmentioning

confidence: 99%

Evaluation of kidney damage in patients with acute lymphoblastic leukemia in long‐term follow‐up: Value of renal scan

Yetgin

Olgar

Aras³

et al. 2004

American J Hematol

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“…In this cross-sectional study, we evaluated 108 children (68 boys and 40 girls) who were diagnosed with ALL at Hacettepe University Hospital between January 1995 and December 2000 and treated according to the current ALL protocols of Hacettepe University Childhood Leukemia Study Group, which was the St. Jude ALL Total Therapy Study XI protocol with minor modification [17,18]. The patients were divided into two groups.…”

Section: Patientsmentioning

confidence: 99%

“…The patients were divided into two groups. In order to have matched groups with respect to the time intervals after cessation of chemotherapy, 59 patients [36 boys and 23 girls; median age 11.7 years (range [6][7][8][9][10][11][12][13][14][15][16][17][18][19]] out of 108 were enrolled in the study. The only difference of the two protocols was the dose of corticosteroid during remission-induction chemotherapy: group 1 (n ¼ 30) received ''conventional-dose prednisolone therapy (CDP; prednisolone, 2 mg/kg/day, orally)'' and group 2 (n ¼ 29) received ''high-dose methylprednisone therapy (HDMP; Prednol-L, 900-600 mg/m 2 , orally)'' ( Table I).…”

Section: Patientsmentioning

confidence: 99%

“…Recently, the Hacettepe University Childhood Leukemia Study Group showed the significant efficacy of high-dose methylprednisolone (HDMP) in comparison with conventional-dose prednisolone (CDP) applied during remission-induction chemotherapy of ALL patients on event-free survival and relapse rate [17,18]. The purpose of the present study was to compare the influence of different steroid doses on BMD and serum bone turnover markers in survivors of childhood ALL after cessation of chemotherapy.…”

Section: Introductionmentioning

confidence: 99%

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Bone mineral density and serum bone turnover markers in survivors of childhood acute lymphoblastic leukemia: Comparison of megadose methylprednisolone and conventional‐dose prednisolone treatments

et al. 2005

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During recent decades, the survival rate after childhood acute lymphoblastic leukemia (ALL) has improved substantially; consequently, the long-term side effects of ALL and its treatment have gained attention, of which osteoporosis is one of the most important. The purpose of the present study was to compare the influence of different treatment protocols that include high-dose methylprednisolone (HDMP) versus conventional-dose prednisolone (CDP) for remission-induction therapy on bone mineral density (BMD) and serum bone turnover markers in survivors of childhood ALL after cessation of chemotherapy. Thirty-six boy and 23 girl survivors, treated for ALL, were cross-sectionally studied, at a mean age of 11.7 years (range 6-19). Group 1 (n = 30) received CDP therapy (prednisolone, 2 mg/kg/day, orally) and group 2 (n = 29) received HDMP therapy (prednol-L, 900-600 mg/m 2 , orally). All other therapies were similar in both groups. Cranial irradiation was added for high-risk patients as soon as possible after consolidation therapy. We found that mean lumbar spine BMD z score value was -1.75 (0.83) SDS in group 1 and -1.66 (1.21) SDS in group 2. There is no difference between both groups (P = 0.736). The mean BMD z scores of prepubertal and pubertal patients were not significantly different in both groups. Comparison of serum bone turnover parameters of the patients revealed no difference between the two groups. Stepwise regression analysis revealed that lumbar spine BMD z scores was predicted by height SDS and the time past since cessation of therapy, but not age at diagnosis, BMI SDS, cranial radiotherapy, and puberty. Our study results showed that HDMP treatment did not deteriorate the bone mass any more than CDP treatment. These results proved that high-dose steroid therapy over a short period of time in remission-induction treatment would not affect the bone mass any more adversely than would conventional doses approximately 3 years after cessation of chemotherapy. Am.

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“…Furthermore, we found that the 8-year EFS was significantly higher [14]. To verify whether HDMP was more effective on blast reduction rate than conventional dose steroid therapy, we analyzed the outcome of 194 ALL patients for initial response and presenting features.…”

Section: Introductionmentioning

confidence: 98%

The Dose Related Effect of Steroids on Blast Reduction Rate and Event Free Survival in Children with Acute Lymphoblastic Leukemia

Yetgin

Çetin

2003

Leukemia & Lymphoma

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We examined the effect of high-dose methylprednisolone (HDMP) on blast reduction rate and compared it to conventional dose steroid treatment, administered during the first 7+ days of the induction remission period in patients with acute lymphoblastic leukemia (ALL). In our previous randomized study, the event free survival (EFS) was found to be higher in patients treated with HDMP (Group B) than in patients treated with a conventional dose of steroids (Group A). We used the chemotherapy protocol for ALL patients according to the St Jude Total XI study group. Medical records of all 194 patients who achieved complete remission were reviewed to determine the absolute blast count (ABC) in peripheral blood smears from day 0 of treatment until day 8. A target response of 1,000 blast/mm3 was employed. The time in which ABC remained > or = 1,000/mm3 and the EFS rates were assessed in group A (n = 44) and B (n = 51) of high risk patients. Group A and B patients were branched to chemotherapy schedules (A1, B1: steroid + vincristine + daunorubicine + intrathecal + 3 doses L-asparaginase; A2, B2: steroid + vincristine + daunorubicine + intrathecal; A3, B3: only steroid monotherapy). Number of patients from whom the ABC remained > or = 1,000/mm3 during all 7 days of induction treatment and the median number of days for blasts to reach the target level were significantly lower in group B1 than A1 (p < 0.05), concordantly the 8-year EFS was higher in group B1 (p = 0.01). In comparison of the subgroups, results of A2 and A3 were worse than of group B2 and B3. These findings strongly suggest that the effects of HDMP on blast cytoreduction and EFS are more potent than conventional dose steroids.

show abstract

Benefit of high-dose methylprednisolone in comparison with conventional-dose prednisolone during remission induction therapy in childhood acute lymphoblastic leukemia for long-term follow-up

Cited by 29 publications

References 30 publications

Evaluation of kidney damage in patients with acute lymphoblastic leukemia in long‐term follow‐up: Value of renal scan

Evaluation of kidney damage in patients with acute lymphoblastic leukemia in long‐term follow‐up: Value of renal scan

Bone mineral density and serum bone turnover markers in survivors of childhood acute lymphoblastic leukemia: Comparison of megadose methylprednisolone and conventional‐dose prednisolone treatments

The Dose Related Effect of Steroids on Blast Reduction Rate and Event Free Survival in Children with Acute Lymphoblastic Leukemia

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