Myeloprotective effect of short‐course high‐dose methylprednisolone treatment before consolidation therapy in children with acute myeloblastic leukemia

Abstract

In our previous studies, short-course high-dose methylprednisolone (HDMP) has been shown to shorten the chemotherapy-induced neutropenic period by stimulating the CD34 + hematopoietic progenitor cells in children with acute leukemia. In this study, we investigate the role of short-course HDMP on induction of a myeloprotective effect when administered before consolidation therapy consisting of high-dose cytosine arabinoside and daunorubicin. Thirty-four consecutive newly diagnosed children with acute myeloblastic leukemia (AML) who received 64 courses of consolidation regimen were entered into the study. The patients received HDMP (group A) at a daily dose of 30 mg/kg methylprednisolone starting 4 days before the initiation of consolidation therapy. The control group did not receive HDMP (group B). There were no differences in the white blood cell (WBC) and absolute neutrophil counts (ANC) between group A (at day -4) and group B (at day 0) at the beginning of the study (medians: 3 · 10 9 /L vs. 3.2 · 10 9 /L and 1.5 · 10 9 /L vs. 1.7 · 10 9 /L, respectively). The WBC count increased significantly from 3 · 10 9 /L to 6.4 · 10 9 /L, and ANC increased from 1.5 · 10 9 /L to 3.9 · 10 9 /L after 4 days of HDMP treatment in group A (P < 0.01). Following high-dose chemotherapy, the median values of WBC and ANC also remained higher than the control values during the 16 days of the follow-up period. The neutropenic period was significantly shorter in the HDMP group than in the control group (9 ± 5.2 days vs. 22 ± 4.7 days) (P < 0.05). The duration of hospitalization and the interval between two chemotherapy cycles were significantly decreased in group A when compared group B (9 ± 2.7 vs. 14 ± 2.7 days; 22 ± 4.7 vs. 26 ± 4.2 days, respectively) (P < 0.05). Moreover, following consolidation therapy, the number of patients with ANC values below 0.5 · 10 9 /L was lower in group A when compared the group B. In conclusion, the administration of short-course (4 days) HDMP before high-dose chemotherapy has been found to be beneficial for reducing the duration and severity of neutropenia. Further studies with short-course HDMP are required to evaluate its myeloprotective effects in patients with other malignancies.

Comparison of the approaches to non‐febrile neutropenia developing in children with acute lymphoblastic leukemia

“…The most important factors limiting the use of G‐CSF are its high cost and requirement of parenteral administration [9]. In our study, cost analysis made in groups receiving myelopoiesis‐inducing treatments revealed that the mean cost of treatment per neutropenic attack was statistically higher in the G‐CSF group than the HDMP group.…”

“…Despite mild and temporary side effects, short‐lasting HDMP treatment is a well‐tolerated therapeutic option [6,9,24,28,29]. In our study, none of patients had intolerable side effects or infections requiring cancellation of the treatments.…”

“…In a study conducted by Elmas et al. [9] in newly diagnosed cases of acute myeloblastic leukemia, it has been found that patients who had received HDMP for 4 days prior to consolidation had higher neutrophil counts during the 16‐day treatment period than those who had not and also had shorter duration of neutropenia and shorter lapses between two consecutive treatment cure. Besides, their HDMP group had fewer patients with ANC < 500/mm 3 following the consolidation treatment.…”

“…Besides, their HDMP group had fewer patients with ANC < 500/mm 3 following the consolidation treatment. HDMP treatment has been found to be safe and successful in reducing the duration of neutropenia developing secondary to chemotherapy in patients with acute leukemia [7,9,24]. Hiçsönmez et al.…”

“…On the other hand, Elmas et al. [9] have reported that the frequency of infections in patients to whom they had administered HDMP for 4 days prior to consolidation therapy was lower than that in patients not receiving HDMP; however, the difference was not statistically significant.…”