Pulse therapy with vincristine and dexamethasone for childhood ALL

Vincristine plus dexamethasone pulses are generally used throughout maintenance treatment for childhood ALL. A randomised non-inferiority trial at 20 centers in China investigated if this treatment could be safely omitted beyond 1 year of treatment in patients in continuous remission. Among children with low-risk disease the five-year EFS rate was 90.3% with vincristine plus dexamethasone pulses in the second year versus 90.2% without pulses in the second year (p=0.90) with a one-sided 95% upper confidence bound for the difference in 5-year EFS probability of 0.024, establishing non-inferiority. Among children with intermediate-to-high risk disease five-year EFS rates were 82.8% with versus 80.8% without pulses in the second year, giving a borderline inferior result for the experimental group. The authors conclude that vincristine plus dexamethasone pulses might be omitted beyond 1 year of treatment for children with low-risk ALL, while additional studies are needed for intermediate-to-high risk ALL.