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Prednisone response predicts outcome in childhood ALL

מתוך medicontext.co.il

WESTPORT, CT (Reuters Health) – A good response to prednisone treatment predicts a good outcome in childhood acute lymphoblastic leukemia (ALL), researchers in Argentina report.

Although early response to therapy is an important predictor of complete remission in children with ALL, the authors note, how best to determine treatment response is controversial.

Dr. Marםa S. Felice and colleagues, from the Hospital de Pediatrםa SAMIC Prof. Dr. J. P. Garrahan in Buenos Aires, analyzed the outcomes of 337 children and adolescents with ALL who showed a good prednisone response.

For patients showing a good prednisone response the 5-year event-free survival was 67%, the authors report in the October issue of the Journal of Pediatric Hematology/Oncology. In contrast, the rate was 38% in the group with poor reponse to prednisone (p = 0.0001).

Of the patients in the good-response group, those with at least 1000 blasts/µL in their initial WBC count showed higher mean WBC count, more mediastinal involvement and spleen enlargement, and a greater likelihood of T immunophenotype at baseline than did those with less than 1000 blasts/µL, the report indicates.

Despite those baseline differences, the researchers note, there were no statistical differences in response to induction phase, deaths during induction phase, deaths in complete remission, number of relapses, or event-free survival between the initial blast count subgroups.

"It is still unclear whether these multiple prognostic factors can be incorporated into a practical and reliable system of risk assessment," Dr. Ching-Hon Pui from St. Jude Children's Research Hospital in Memphis, Tennessee writes in a related editorial.

"One scenario," Dr. Pui suggests, "predicts the use of different combinations of leukemic cell characteristics, in vivo drug sensitivity testing, and normal host cell pharmacogenetic determinations to estimate the failure risk for individual patients, who then would be considered candidates for unique risk-based therapies."

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