Which steroids should we choose for the treatment of adult acute lymphoblastic leukemia?

• Published in: American journal of hematology 2010-10, Vol.85 (10), p.817-818
• Main Authors: Zheng, Changcheng, Liu, Xin, Wu, Jingsheng, Cai, Xiaoyan, Zhu, Weibo, Sun, Zimin
• Format: Article
• Language: English
• Subjects: Adult; Age Factors; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Asparaginase - administration & dosage; Biological and medical sciences; Daunorubicin - administration & dosage; Dexamethasone - administration & dosage; Dexamethasone - adverse effects; Disease-Free Survival; Female; Follow-Up Studies; Hematologic and hematopoietic diseases; Humans; Infection - epidemiology; Leukemias. Malignant lymphomas. Malignant reticulosis. Myelofibrosis; Male; Medical sciences; Middle Aged; Precursor Cell Lymphoblastic Leukemia-Lymphoma - drug therapy; Prednisolone - administration & dosage; Prednisolone - adverse effects; Remission Induction; Risk; Treatment Outcome; Vincristine - administration & dosage
• ISSN: 0361-8609; 1096-8652
• DOI: 10.1002/ajh.21827

Corticosteroids are essential and one of the mainstays in the treatment of acute lymphoblastic leukemia (ALL). In vitro assays show that dexamethasone(DXM) is five to six times more cytotoxic to leukemic lymphoblasts than prednisolone (PDN) [1], and the use of DXM as an alternative drug for PDN is an important issue in the treatment of childhood ALL. The current randomized comparisons in childhood ALL indicated a statistically significant and clinically important decrease in rate of isolated central nervous system (CNS) relapses and an increase in event-free survival (EFS) with DXM. However, the data were limited in adult ALL. Recently, Labar et al. [2] reported their first investigation in comparison of the antileukemic activity and toxicity between DXM and PDN for adult patients with ALL and lymphoblastic lymphoma (LBL) through a randomized clinical trial (the ALL-4 trial of the EORTC Leukemia Group), and the author concluded that DXM as a steroid therapy for adult patients with ALL/LBL did not show any benefit compared with PDN, which did not support the experience from several other pediatric studies. In Labar’s observation, about 70% of adult patients were high risk (HR) ALL. Most of the patients in pediatric trials were standard risk (SR) ALL. In our study, we also evaluate the role of DXM compared with PDN during induction or subsequent phases of therapy in adult ALL with emphasis on SR group.