Benefit of dexamethasone compared with prednisolone for childhood acute lymphoblastic leukaemia: results of the UK Medical Research Council ALL97 randomized trial
Benefit of dexamethasone compared with prednisolone for childhood acute lymphoblastic leukaemia: results of the UK Medical Research Council ALL97 randomized trial
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DOI：
10.1111/j.1365-2141.2005.05509.x
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发表时间：
2005-06-01
影响因子：
6.5
通讯作者：
Eden, TOB
中科院分区：
文献类型：
--
作者：
Mitchell, CD;Richards, SM;Eden, TOB
皮质类固醇是治疗急性淋巴细胞白血病（ALL）的重要组成部分。泼尼松龙是最常用的类固醇，特别是在治疗的维持阶段。越来越多的证据表明，即使在与糖皮质激素作用等效的剂量下，与泼尼松龙相比，地塞米松也具有增强的淋巴母细胞细胞毒性和中枢神经系统（CNS）渗透。因此，在ALL治疗中用地塞米松替代泼尼松龙可能会改善无事件生存率和总生存率。新诊断的ALL患儿被随机分配在诱导期、巩固期（均在强化期接受地塞米松）和持续期接受地塞米松或泼尼松龙治疗。在1603例符合条件的随机化患者中，接受地塞米松治疗的患者发生孤立性CNS复发的风险为一半（P = 0.0007）。地塞米松组的无事件生存率显著提高（5年时84.2% vs. 75.6%; P = 0.01），没有证据表明在任何亚组患者中有不同的效果。在ALL治疗期间使用6.5 mg/m2地塞米松可显著降低所有风险组患者的复发风险，尽管毒性增加，但现在应将其视为儿童ALL标准治疗的一部分。
Corticosteroids are an essential component of treatment for acute lymphoblastic leukaemia (ALL). Prednisolone is the most commonly used steroid, particularly in the maintenance phase of therapy. There is increasing evidence that, even in equipotent dosage for glucocorticoid effect, dexamethasone has enhanced lymphoblast cytotoxicity and penetration of the central nervous system (CNS) compared with prednisolone. Substitution of dexamethasone for prednisolone in the treatment of ALL might, therefore, result in improved event-free and overall survival. Children with newly diagnosed ALL were randomly assigned to receive either dexamethasone or prednisolone in the induction, consolidation (all received dexamethasone in intensification) and continuation phases of treatment. Among 1603 eligible randomized patients, those receiving dexamethasone had half the risk of isolated CNS relapse (P = 0.0007). Event-free survival was significantly improved with dexamethasone (84.2% vs. 75.6% at 5 years; P = 0.01), with no evidence of differing effects in any subgroup of patients. The use of 6.5 mg/m(2) dexamethasone throughout treatment for ALL led to a significant decrease in the risk of relapse for all risk-groups of patients and, despite the increased toxicity, should now be regarded as part of standard therapy for childhood ALL.