CHENNAI: A multicentre clinical trial involving Chennai’s Cancer Institute (WIA) has found that a modified steroid schedule during childhood leukaemia treatment can significantly reduce treatment-related deaths without affecting survival rates, offering a possible shift in treatment approach for low-resource settings.
The findings, published in The Lancet Regional Health–Southeast Asia, come from one of India’s largest paediatric leukaemia trials conducted across 6 cancer centres between 2016 and 2022.
The study focused on acute lymphoblastic leukaemia (ALL), the most common cancer among children. Researchers said that infections and sepsis during chemotherapy continue to remain a major cause of treatment-related deaths in countries such as India despite improvements in cancer care. The trial examined whether reducing continuous exposure to prednisolone, a steroid routinely used during the induction phase of treatment, could lower mortality linked to severe infections.
A total of 1,246 children below 10 years of age with standard- and intermediate-risk B-cell precursor ALL were randomly assigned to two treatment groups. One group received the conventional four-week continuous steroid regimen, while the other received prednisolone in two shorter phases separated by a treatment break.
The study found that deaths during induction therapy were lower among children who received the pulsed steroid schedule. According to the findings, 22 children out of 623 in the conventional treatment arm died during induction therapy, compared with eight out of 623 in the pulsed steroid arm.
Researchers said the revised schedule reduced early infection-related deaths without compromising treatment response, remission rates or long-term survival outcomes. “Pulsed prednisolone during induction significantly reduced treatment-related deaths, particularly early deaths from infections, without compromising remission rates or survival outcomes,” the study said.
The paper noted that infections accounted for most deaths during the induction phase, with prolonged steroid exposure and anthracycline chemotherapy increasing vulnerability to severe bacterial and fungal infections. Researchers said that the findings underline the need to adapt treatment protocols to local healthcare conditions instead of uniformly following intensive regimens developed in high-income countries.
The Cancer Institute (WIA), Adyar, was among the 6 centres that participated in the trial conducted under the Indian Childhood Collaborative Leukaemia group. Doctors from the Chennai institute were among the study’s co-authors.