High-dose methotrexate worked better than Capizzi methotrexate and resulted in no increased acute toxicity in patients with high-risk B-acute lymphoblastic leukemia, according to a study involving nearly 3,000 individuals.

Participants were randomly assigned to receive dexamethasone for 14 days vs prednisone for 28 days during induction, and high-dose methotrexate vs Capizzi escalating-dose methotrexate plus pegaspargase during interim maintenance. Among the results:

• High-dose methotrexate regimens were superior, so much so that trial enrollment ended early.

• At the time, those receiving high-dose methotrexate had an 82% 5-year event-free survival rate, vs 75% for Capizzi methotrexate.

• By the end of the trial those rates were 80% for high-dose methotrexate and 75% for Capizzi methotrexate.

• High-dose methotrexate decreased both marrow and central nervous system recurrences.

• Younger patients benefitted more from dexamethasone during induction than their older counterparts.

Citation: Larsen E, Devidas M, Chen S, et al. Dexamethasone and high-dose methotrexate improve outcome for children and young adults with high-risk B-acute lymphoblastic leukemia: A report from Children’s Oncology Group Study. [Published online ahead of print April 25, 2016]. J Clin Oncol. doi:10.1200/JCO.2015.62.4544.