{"entity":{"id":"paper-aall0232-larsen-jco-2016","kind":"paper","name":"AALL0232: dexamethasone and high-dose methotrexate improve outcome in high-risk B-cell acute lymphoblastic leukaemia in children and young adults","aka":[],"tldr":"In high-risk childhood B-cell acute lymphoblastic leukaemia, high-dose methotrexate beat escalating-dose methotrexate, and dexamethasone beat prednisone in children under 10, defining the backbone still used in Children's Oncology Group trials.","summary":"Phase 3 factorial trial of 3,154 patients aged 1 to 30 with high-risk B-ALL randomised to dexamethasone or prednisone during induction and to high-dose methotrexate or Capizzi escalating methotrexate with asparaginase during interim maintenance.\n\nFive-year event-free survival was 79.6 percent with high-dose methotrexate against 75.2 percent with Capizzi methotrexate; dexamethasone improved event-free survival in patients under 10 (91.2 versus 83.2 percent) but increased osteonecrosis in older patients.","asOf":"2026-09-17","links":[{"label":"J Clin Oncol 2016","url":"https://doi.org/10.1200/JCO.2015.62.4544"},{"label":"PubMed","url":"https://pubmed.ncbi.nlm.nih.gov/27114587/"}],"tags":[],"related":[],"cancers":["all-paediatric-high-risk"],"sections":[],"technologies":[],"targets":[],"drugs":["dexamethasone","methotrexate"],"companies":[],"institutions":[],"pathways":[],"terms":[],"trials":[],"people":[],"bottlenecks":[],"keyPapers":[],"journals":["jco"],"dependsOn":[],"notes":[],"journal":"Journal of Clinical Oncology","year":2016,"doi":"10.1200/JCO.2015.62.4544","pmid":"27114587","authors":"Larsen EC, Devidas M, Chen S, et al.","paperType":"rct","findings":["Five-year event-free survival 79.6 percent (high-dose methotrexate) vs 75.2 percent (Capizzi).","Dexamethasone benefit in patients under 10; more osteonecrosis in those 10 and over."],"whatItMeans":"High-dose methotrexate interim maintenance and age-adapted steroid choice are standard in high-risk paediatric B-ALL protocols.","caveats":["Large factorial design with interactions between the two randomisations."],"changedPractice":true,"participants":3154},"route":"/key-papers/paper-aall0232-larsen-jco-2016/","neighbours":{"cancer":[{"id":"all-paediatric-high-risk","kind":"cancer","name":"High-risk acute lymphoblastic leukaemia in children (high-risk B-ALL and T-ALL)","route":"/cancers/all-paediatric-high-risk/"}],"drug":[{"id":"dexamethasone","kind":"drug","name":"Dexamethasone","route":"/drugs/dexamethasone/"},{"id":"methotrexate","kind":"drug","name":"Methotrexate","route":"/drugs/methotrexate/"}],"journal":[{"id":"jco","kind":"journal","name":"Journal of Clinical Oncology","route":"/journals/jco/"}]}}