19. Remission induction in childhood lymphoblastic leukemia

  1. Ross Pinkerton MB, BCh, BaO, MD Executive Director, Division of Oncology2,
  2. Ananth Shankar MD, FRCPCH Consultant in Paediatric and Adolescent Oncology3 and
  3. Katherine K. Matthay BA, MD Mildred V. Strouss Professor of Translational Oncology, Director, Pediatric Hematology-Oncology4
  1. Ananth Shankar

Published Online: 8 MAY 2013

DOI: 10.1002/9781118625309.ch19

Evidence-Based Pediatric Oncology

Evidence-Based Pediatric Oncology

How to Cite

Shankar, A. (2013) Remission induction in childhood lymphoblastic leukemia, in Evidence-Based Pediatric Oncology (eds R. Pinkerton, A. Shankar and K. K. Matthay), John Wiley & Sons, Ltd, Oxford. doi: 10.1002/9781118625309.ch19

Editor Information

  1. 2

    Royal Children's Hospital, Children's Health Queensland, Brisbane, QLD, Australia

  2. 3

    University College London Hospitals NHS Foundation Trust London, UK

  3. 4

    Department of Pediatrics, UCSF School of Medicine and, UCSF Benioff Children's Hospital, San Francisco, CA, USA

Author Information

  1. University College London Hospitals NHS Foundation Trust, London, UK

Publication History

  1. Published Online: 8 MAY 2013
  2. Published Print: 20 MAY 2013

ISBN Information

Print ISBN: 9780470659649

Online ISBN: 9781118625309



  • childhood acute lymphoblastic leukemia (cALL);
  • children;
  • remission induction chemotherapy;
  • steroids


Prednisolone (PDN) was the main steroid used in early trials during the remission induction phase of treatment in childhood lymphoblastic leukemia. However, with the development of other forms of synthetic steroids with potent glucocorticoid activity, it became clear that some might be more potent, with greater antileukemic activity than prednisolone. The randomized trial by Yetgin et al. compared high-dose intravenous (IV) methylprednisolone (HDMP) against standard prednisolone (PDN) during remission induction in previously untreated children with common childhood acute lymphoblastic leukemia (cALL). The authors concluded that high-dose intravenous (IV) methylprednisolone (HDMP) during remission induction chemotherapy improved the event-free survival (EFS) rate significantly for high-risk patients and improved survival outcome. Remission induction chemotherapy comprised weekly vincristine, daily oral steroid as randomized PDN or dexamethasone (DEX) and Erwinia asparaginase (E Asp). All patients received the same randomized steroid during remission induction, intensification, and the continuing phase of treatment.