An Overview of Early Response to Dexamethasone as Prognostic Factor: Result from Indonesian Childhood WK-ALL Protocol in Yogyakarta

Early response to treatment has been shown to be an important prognostic factor of childhood acute
lymphoblastic leukemia (ALL) patients in Western studies. We studied this factor in the setting of a
low-income province in 165 patients treated on Indonesian WK-ALL-2000 protocol between 1999 and
2006. Poor early response, defined as a peripheral lymphoblasts count of ≥1000/μL after 7 days of
oral dexamethasone plus one intrathecal methotrexate (MTX), occurred in 19.4% of the patients. Poor
responders showed a higher probability of induction failures compared to good responders (53.1%
versus 23.3%, P < 0.01), higher probability of resistant disease (15.6% versus 4.5%, P = 0.02),
shorter disease-free survival (P = 0.034; 5-year DFS: 24.9% ± 12.1% versus 48.6% ± 5.7%), and
shorter event-free survival (P = 0.002; 5-year EFS: 9.7% ± 5.3% versus 26.3% ± 3.8%). We observed
that the percentage of poor responders in our setting was higher than reported for Western countries
with prednisone or prednisolone as the steroids. The study did not demonstrate a significant additive
prognostic value of early response over other known risk factors (age and white blood cell count) for
DFS and only a moderately added value for EFS.