Effect of Prechemotherapy Steroid on Initial Tumor Load: An Outcome Indicator of Induction of Remission in Childhood Acute Lymphoblastic Leukemia (ALL)

MUHAMMAD TAWFIQUE1, RASHED JAHANGIR KABIR2, CHOWDHURY YAKUB JAMAL3,ABDUL MANNAN MIA4, NAJNIN UMME ZAKIA5

Abstract

Background: Treatment of Acute Lymphoblastic Leukemia (ALL) is mainly
chemotherapy based. In the past outcome of treatment with polychemotherapy was
dissatisfying. Recently success have improved as risk based polychemotherapy has
been employed. Therefore in modern approach of the treatment of ALL of children
assessment of risk factors has become a key issue. It has been observed in the
studies abroad that response to prechemotherapy corticosteroid could be a clue to
the good response to chemotherapy
Objectives: The objectives of this study were to see the effects of dexamethasone
on initial tumor load and to observe the relationship of the effects of prechemotherapy
dexamethasone on tumor burden and the outcome of Induction of Remission.
Materials and Methods: This was a prospective study carried out from January 2004
to June 2005 in the Department of Pediatric Hematology and Oncology at Bangabandhu
Sheikh Mujib Medical University (BSMMU). All the cases between one to fourteen
years of either genders were enrolled into the study after their confirmation as ALL.
Tumor load was assessed before the beginning of prechemotherapy dexamethasone
and after the day 7 of prechemotherapy dexamethasone. After reassessment of tumor
load, polychemotherapy of Induction of Remission was begun. Bone marrow study
was performed every seven days after starting Induction chemotherapy until the bone
marrow remission was achieved. Then the effect of prechemotherapy dexamethasone
on tumor load was compared with the outcome of Induction polychemotherapy. The
results were analyzed maintaining standard procedure with SPSS version 10.0.
Results: A total of 40 patients were enrolled into the study. Among them 21 were male
and nineteen were female. Thirty were FAB L1 and ten were L2 morphologically. Reduction
of tumor load was evident as estimated by peripheral blast count together with hepatic
and splenic mass. Response to prechemotherapy dexamethasone was good in 21 out of
28 patients with the WBC count below 50×109/L as compared to only 4 out of 12 with the
WBC count >50×109/L (P=0.013). Similarly, 21 in 24 in the group <25×109/L of Initial
Blast Cell count responded good as compared to 4 in 16 with >25×109/L Initial Blast Cell
count (P=0.000). Among the 25 good responders to prechemotherapy dexamethasone
24 went into remission within 7 days of induction and among the 15 poor responders only
6 went into remission within 7 days of induction (P=0.000).
Conclusion: Response to pre-chemotherapy dexamethasone could be a strong guide
to predict the outcome of induction chemotherapy and help in risk stratification of
childhood Acute Lymphoblastic Leukemia.
Keywords: Prechemotherapy, initial tumor, ALL, Dexamethasone.

 

Download PDF