Thromboembolism (TE) in children with acute lymphoblastic leukemia (ALL) treated on Dana Farber Cancer Institute (DFCI) protocols: Effect of dose and type (prednisone versus dexamethasone) of steroids used
Bibliographic record
Abstract
8525 Background: Comparison of two multi-institutional Berlin-Frankfurt-Munster (BFM)-ALL studies showed that dexamethasone (Dex), instead of prednisone (Pred), with asparaginase (ASP) significantly reduces the risk of TE. To confirm this observation, we studied the effect of dose and type of steroids used in combination with ASP on incidence of TE in children with ALL treated at a single institution on three consecutive DFCI-ALL protocols. Methods: Data on prospectively assembled cohorts of children (≤ 18 years) was analyzed. All patients received similar induction therapy including Pred. During intensification therapy, patients received either Dex (protocol 91–01) or Pred (protocol 95–01) or were randomized to receive Pred or Dex (protocol 20–01) at 5/21 days cycles with weekly ASP. On all 3 protocols, high-risk patients received high-dose (HD) steroids (Pred 120 mg/m2/d or Dex 18 mg/m2/d) while standard-risk patients received low-dose (LD) steroids (Pred 40 mg/m2/d or Dex 6 mg/m2/d). Results: In all 129 patients were eligible for analysis. Details of steroids during intensification and frequency of TE in each group are shown in Table. On 20–01 protocol, 3 of 21 (14.3%) patients on Pred had TE compared with 3 of 16 (18.7%) on Dex (p=1.0). Conclusions: The dose, but not the type, of steroid used in combination with ASP significantly altered the risk of TE in children treated on DFCI-ALL protocols. Patients receiving HD steroids were at significantly increased risk of TE. Unlike BFM studies, Dex in combination with ASP was not associated with lower risk of TE. Randomized controlled trials with larger patient populations are recommended to confirm these results. No significant financial relationships to disclose.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.004 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".