HIGH-DOSE METHYLPREDNISOLONE, LOW-DOSE CYTOSINE-ARABINOSIDE, AND MITOXANTRONE IN CHILDREN WITH MYELODYSPLASTIC SYNDROMES

High-dose methylprednisolone (HDMP) has been shown to induce different iation of myeloid leukemic cells with a remarkable antileukemic effect in children with various subtypes of acute myeloblastic leukemia (AML ), therefore we used HDMP in the treatment of four children with myelo dysplastic syndrome (MDS). Two patients had refractory anemia with an excess of blasts in transformation (RAEB-t) with extramedullary infilt ration (EMI), one had chronic myelomonocytic leukemia with pleural eff usion, and one had RAEB. HDMP was administered orally at a single dose of 20-30 mg/kg/day, combined with low-dose cytosine arabinoside (LD A ra-C) (10 mg/m(2), 12-hourly SC) for 2 weeks. The treatment continued with mitoxantrone (10 mg/m(2), IV) and Ara-C (5 mg/kg, IV) once a week for four doses followed by maintenance chemotherapy. All patients ach ieved hematologic remission 2-4 weeks after initiation of treatment. E xtramedullary infiltration disappeared in all cases within 2 weeks to 3 months after initiation of therapy. With the exception of two patien ts who relapsed 6 and 24 months after remission, treatment could be st opped in others who remained in remission for 36 months without eviden ce of EMI; 6 months later one of them developed myelodysplastic relaps e (RAEB). No side effects related to HDMP treatment were noted, but hy perleukocytosis developed in two patients who initially had high WBC c ounts. We suggest that the addition of HDMP with or without LD Ara-C t o cytotoxic chemotherapy offers a promising alternative in cases not c onsidered suitable for bone marrow transplantation.