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In high-risk childhood B-cell acute lymphoblastic leukaemia, high-dose methotrexate beat escalating-dose methotrexate, and dexamethasone beat prednisone in children under 10, defining the backbone still used in Children's Oncology Group trials.
Phase 3 factorial trial of 3,154 patients aged 1 to 30 with high-risk B-ALL randomised to dexamethasone or prednisone during induction and to high-dose methotrexate or Capizzi escalating methotrexate with asparaginase during interim maintenance.
Five-year event-free survival was 79.6 percent with high-dose methotrexate against 75.2 percent with Capizzi methotrexate; dexamethasone improved event-free survival in patients under 10 (91.2 versus 83.2 percent) but increased osteonecrosis in older patients.
High-dose methotrexate interim maintenance and age-adapted steroid choice are standard in high-risk paediatric B-ALL protocols.
Shares High-risk acute lymphoblastic leukaemia in children (high-risk B-ALL and T-ALL), Journal of Clinical Oncology.
Shares Methotrexate, Journal of Clinical Oncology.
Shares High-risk acute lymphoblastic leukaemia in children (high-risk B-ALL and T-ALL), Journal of Clinical Oncology.
Shares Methotrexate, Journal of Clinical Oncology.
Shares High-risk acute lymphoblastic leukaemia in children (high-risk B-ALL and T-ALL), Methotrexate.
Shares High-risk acute lymphoblastic leukaemia in children (high-risk B-ALL and T-ALL), Dexamethasone.
Shares Methotrexate, Dexamethasone.