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Journal of Oncology
Volume 2012, Article ID 417941, 8 pages
Clinical Study

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

1Pediatric Hematology and Oncology Division, Department of Pediatrics, Dr. Sardjito Hospital, Medical Faculty, Universitas Gadjah Mada, Yogyakarta, Indonesia
2Department of Epidemiology and Biostatistics, VU University Medical Center, 1007MB Amsterdam, The Netherlands
3Pediatric Oncology/Hematology Division, Department of Pediatrics, VU University Medical Center, 1007MB Amsterdam, The Netherlands

Received 23 November 2011; Revised 24 January 2012; Accepted 25 January 2012

Academic Editor: A. J. M. Balm

Copyright © 2012 Pudjo H. Widjajanto et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


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 . 0 1 ), higher probability of resistant disease (15.6% versus 4.5%, 𝑃 = 0 . 0 2 ), shorter disease-free survival ( 𝑃 = 0 . 0 3 4 ; 5-year DFS: 24.9% ± 12.1% versus 48.6% ± 5.7%), and shorter event-free survival ( 𝑃 = 0 . 0 0 2 ; 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.