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Efficacy and toxicity of dexamethasone vs methylprednisolone—long-term results in more than 1000 patients from the Russian randomized multicentric trial ALL-MB 2002

Leukemia volume 29, pages 1955–1958 (2015)Cite this article

Subjects

Optimal choice of glucocorticoids (GC), like dexamethasone (DEXA) vs (methyl)prednisolone (MePRED) for remission induction in childhood acute lymphoblastic leukemia (ALL) remains controversial. The favorable antileukemic efficacy of DEXA is off-set by its dose-limiting toxicity.1, 2 Hence, one objective of trial ALL-Moscow/Berlin (MB) 2002 was to evaluate whether an equiactive dose of MePRED leads to superior event-free survival (EFS) rates by reducing mortality, while maintaining the low relapse rates and central nervous system (CNS) protection obtained with DEXA previously.2, 3 Of 1163 pediatric patients with newly diagnosed B-cell precursor or T-cell ALL, 1064 were randomized to induction with either 6 mg/m2 DEXA (n=539) or 60 mg/m2 MePRED (n=525) (Table 1, Supplementary Figure S1, and Table S1)4, 5, 6, 7, 8 as described in Supplementary Subjects and Methods.

Table 1 Patient characteristics and outcome in trial ALL-MB 2002
Full size table

No significant differences were found between randomization arms (RA) regarding gender, age, initial white blood cell count (WBC), CNS involvement, immunophenotype or genetics (Table 1). Thirty-six out of 539 patients in the DEXA arm (6.7%) and 37/525 (7.0%) in the MePRED arm were re-stratified into the high risk group (HRG) due to failure to achieve complete remission (CR), as defined in Supplementary Subjects and Methods, on day 36. Median follow-up (all patients) was 7.04 years (interquartile range (IQR): 5.72–8.25). Adherence to the protocol (Supplementary Table S1) measured by the median duration of induction was similar for both arms (DEXA: 36 days (IQR: 36.5–37.5); MePRED: 36 days (IQR: 36.4–37.7); P=0.98).

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Figure 1

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Acknowledgements

We thank all the members of the charity organization Kontakty-Kontakte e.V., Berlin, in particular project manager Eberhard Radczuweit, for continuous comprehensive support of our efforts to conduct this multicentre trial in Russia. We also thank all the pediatric oncologists and laboratory coworkers from the participating centres involved, the patients and families, colleagues, data managers and technicians of the participating departments for their cooperation and K. Riabowol for his help in preparing the manuscript. This work was supported by the charity organization ‘Kontakty-Kontakte e.V.’, Berlin, Germany.

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Authors and Affiliations

  1. Federal Clinical Research Centre for Pediatric Hematology, Oncology and Immunology, Moscow, Russia

    A Karachunskiy, J Roumiantseva, S Lagoiko, N Korepanova, T Nasedkina, G Novichkova, A Maschan, D Litvinov, N Myakova, A Rumjanzew & G Henze

  2. Department of Oncology, Hematology and radiotherapy, Pirogov Russian National Research Medical University, Moscow, Russia

    A Karachunskiy, J Roumiantseva, G Novichkova, A Maschan, D Litvinov, K Kondratchik & A Rumjanzew

  3. Department of Pediatric Oncology/Hematology, Charité-Universitätsmedizin Berlin, Berlin, Germany

    C Bührer, G Tallen, A von Stackelberg & G Henze

  4. Republic Clinical Research Centre for Pediatric Oncology and Hematology, Minsk, Belarus

    O Aleinikova & O Bydanov

  5. Federal Central Russian Children Hospital, Moscow, Russia

    L Bajdun & N Ponomareva

  6. Engelhardt Institute of Molecular Biology Russian Academy of Sciences, Moscow, Russia

    T Nasedkina

  7. Department of Pediatric Hematology, Morozov Children’s Hospital, Moscow, Russia

    K Kondratchik

  8. Paediatric Oncohematological Centre, Regional Children’s Hospital, Ekaterinburg, Russia

    L Fechina & O Streneva

  9. Department of Pediatric Oncology/Hematology, Regional Children’s Hospital, Voronezh, Russia

    N Judina

  10. Department of Pediatric Oncology/Hematology, Regional Children’s Hospital, Nizhnevartovsk, Russia

    G Scharapova

  11. Department of Pediatric Hematology, Regional Children’s Hospital, Nizhni Novgorod, Russia

    A Shamardina

  12. Department of Pediatric Oncology/Hematology, Regional Children’s Hospital, Tomsk, Russia

    I Gerbek

  13. Department of Pediatric Oncology/Hematology, Regional Oncological Hospital, Orenburg, Russia

    A Shapochnik

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  1. A Karachunskiy
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for the ALL-MB study group

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Correspondence to G Henze.

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Karachunskiy, A., Roumiantseva, J., Lagoiko, S. et al. Efficacy and toxicity of dexamethasone vs methylprednisolone—long-term results in more than 1000 patients from the Russian randomized multicentric trial ALL-MB 2002. Leukemia 29, 1955–1958 (2015). https://doi.org/10.1038/leu.2015.63

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