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Regimen Improves Survival in Childhood Leukemia

Dexamethasone-based treatment particularly improves survival for high-risk patients

FRIDAY, Sept. 11 (HealthDay News) -- A dexamethasone-based chemotherapy regimen improves survival in children with acute lymphoblastic leukemia (ALL) without cranial irradiation or some routinely used chemotherapy drugs, according to a study published online Sept. 10 in The Lancet Oncology.

Anjo J. Veerman, Ph.D., from VU University Medical Centre in Amsterdam, Netherlands, and colleagues categorized 859 patients (up to 18 years of age) with ALL as high-risk (30 percent) and non-high-risk (70 percent) based on clinical criteria. Non-high-risk patients received a dexamethasone-based three-drug induction followed by medium-dose methotrexate and then maintenance therapy, while high-risk patients received a dexamethasone-based four-drug induction followed by high-dose methotrexate and two intensification courses before receiving maintenance therapy.

The researchers found that 98.5 percent of the non-high-risk group and 96.9 percent of the high-risk group achieved complete remission. After a median follow-up of 72.2 months (excluding the nine patients who died during induction), overall five-year event-free survival was 81 percent in all patients, 84 percent in the non-high-risk group and 72 percent in the high-risk group.

"The overall results of the dexamethasone-based Dutch Childhood Oncology Group ALL-9 protocol are better than those of our previous Berlin-Frankfurt-Munster-based protocols ALL-7 and ALL-8," Veerman and colleagues conclude. "The results for non-high-risk patients were achieved with high cumulative doses of dexamethasone and vincristine, but without the use of anthracyclines, etoposide, cyclophosphamide, or cranial irradiation, therefore minimizing the risk of side effects."

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