***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: We report on the outcome of children with Philadelphia positive acute lymphoblastic leukaemia ( Ph+ ALL ) treated on the UK Medical Research Council ( MRC ) trial for childhood ALL , MRC ALL 97 , between January 1997 and June 2002 . Forty‐two ( 2·3 % ) patients were Ph+ . Nineteen ( 45 % ) had < 25 % blasts in bone marrow ( BM ) within the first 2 weeks of treatment and were defined as a good response group ( GRG ) , the others as a poor response group ( PRG ) . Thirty‐six ( 86 % ) achieved first complete remission ( CR1 ) at the end of induction , of which 28 underwent BM transplantation ( BMT ) . The median follow‐up was 42 months ( range , 21–84 ) . The 3‐year event‐free survival ( EFS ; 52 % , 95 % CI , 36–66 % ) was a considerable improvement on the previous MRC UKALL XI trial ( 27 % ) . EFS for the GRG and PRG were 68 % ( 43–84 % ) and 39 % ( 18–59 % ) , respectively ( P = 0·03 ) ; presenting white cell count < 50 × 109/l ( P = 0·02 ) was predictive for overall survival . Changes in the MRC ALL97 trial within the study period result ed in some Ph+ ALL receiving daunorubicin and either prednisolone or dexamethasone during induction . Though the use of daunorubicin during induction was not a prospect i ve study question , EFS was significantly better for those whose induction included this drug ( P = 0·02 ) . Steroid r and omization was not stratified for Ph+ ALL patients and was not predictive for EFS . BMT in CR1 appeared to reduce the risk of a subsequent BM relapse . These results show significant improvement on previous MRC trials ; future therapeutic strategies should include early intensive therapy and BMT in CR1 Despite a widespread belief that glucocorticoid therapy is associated with positive energy balance and excess weight gain there is a dearth of quantitative evidence about its effects and the underlying mechanisms of any effects . The primary aim of the present study was to quantify the effect of dexamethasone and prednisone treatment on energy intake in children treated for childhood acute lymphoblastic leukemia . A secondary aim was to test for differences in excess weight gain between patients treated using the 2 glucocorticoids . We measured energy intake in 26 patients ( mean + /- SD age , 6.3 + /- 2.3 yr ) during a 5-d period " on " steroids and again in the week before steroid treatment .  Changes in body mass index from diagnosis to 1 and 2 yr postdiagnosis were expressed as SD scores . Steroid treatment was associated with a significant increase in energy intake of approximately 20 % ( mean paired difference , 1.7 MJ/d ; SD , 2.8 ; 95 % confidence interval , 0.7 - 2.8 MJ/d ) , with no significant difference between the 2 steroids . The mean change in body mass index SD score was + 0.38 ( SD , 1.10 ; P < 0.05 ) to 1 yr and + 0.68 ( SD , 1.38 ; P < 0.05 ) to 2 yr , with no significant difference between the 2 groups of patients .  Glucocorticoid treatment in childhood acute lymphoblastic leukemia increases energy intake markedly , and this effect contributes to the excess weight gain and obesity characteristic of patients being treated for acute lymphoblastic leukemia In previous clinical trials of childhood acute lymphoblastic leukemia ( ALL ) , dexamethasone result ed in higher event-free survival rates than prednisone , presumably due to greater central nervous system penetration . Dexamethasone 's association with long-term neurocognitive toxicity is unknown . In this multisite study , we measured neurocognitive functioning in 92 children with st and ard-risk ALL , 1 to 9.99 years at diagnosis , at a mean of 9.8 years after r and omization to prednisone ( n = 41 ) or dexamethasone ( n = 51 ) on Children 's Cancer Group ( CCG ) 1922 . No significant overall differences in mean neurocognitive and academic performance scores were found between the prednisone and dexamethasone groups after adjusting for age , sex , and time since diagnosis . The exception was that patients receiving dexamethasone scored one-third of a st and ard deviation worse on word reading ( 98.8 + /- 1.7 vs 104.9 + /- 1.8 ; P = .02 ) . There were no group differences in the distribution of test scores or the parents ' report of neurologic complications , psychotropic drug use , and special education . Further analyses suggested for the dexamethasone group , older age of diagnosis was associated with worse neurocognitive functioning ; for the prednisone group , younger age at diagnosis was associated with worse functioning . In conclusion , our study did not demonstrate any meaningful differences in long-term cognitive functioning of childhood ALL patients based on corticosteroid r and omization . This study is registered with http://www . clinical trials.gov under NCT00085176 objective Disturbances in body weight regulation are often encountered during glucocorticoid treatment and are associated with increased insulin resistance and truncal fat accumulation . Children were investigated who were receiving glucocorticoid treatment for acute lymphoblastic leukaemia ( ALL ) . They were r and omized to receive either prednisolone or dexamethasone as part of induction of remission . This r and omization process provided a suitable opportunity to compare the effects of these two administered steroid on surrogate markers of adipocyte activity ( leptin ) and hyperinsulinaemia/insulin resistance ( SHBG ) The 1997 acute lymphoblastic leukaemia ( ALL ) trial ( ALL97 ) was a r and omised comparison of prednisolone versus dexamethasone and of 6‐mercaptopurine versus 6‐thioguanine . During the first 2 years of the trial , review of survival data showed the preceding trial , UKALL XI , was no better than its predecessor and that survival for childhood ALL in the UK had not improved in the fashion witnessed by other cooperative treatment groups . The therapy template was therefore altered to an American Children ’s Cancer Group ( CCG ) style regimen , including stratification by age , white cell count and early response to therapy by assessment of the bone marrow . This phase of the trial was design ated ALL97/99 . Comparison of the two phases showed that the event‐free survival ( EFS ) for both ALL97 and ALL97/99 was better than previous UKALL trials , as was overall survival ( OS ) for ALL97/99 . Both EFS and OS were significantly better in ALL97/99 than in ALL97 ( at five years , 80·0 % vs. 74·0 % , P = 0·002 ; and 88·0 % vs. 83·5 % , P = 0·005 , respectively ) . Isolated central nervous system ( CNS ) relapse for patients in ALL97/99 was half that in ALL97 ( 3·0 % vs. 4·9 % ) , P = 0·03 ) and the overall CNS relapse rate was halved in ALL97/99 ( 4·4 % vs. 9·6 % , P < 0·00005 ) . There were no significant differences for non‐CNS relapse , induction deaths or deaths in remission between the two phases of the trial Alterations in hemostasis leading to symptomatic thromboembolism have been observed in patients with acute lymphoblastic leukemia ( ALL ) receiving Escherichia coli asparaginase ( CASP ) combined with steroids .  Moreover , hereditary prothrombotic risk factors are associated with an increased risk for venous thromboembolism in pediatric ALL patients treated according to the BFM 90/95 protocol s ( including  CASP combined with prednisone during induction therapy ) . To assess whether the thromboembolic risk associated with established prothrombotic risk factors is modified by treatment modalities ( prednisone or dexamethasone ) , the present analysis was performed . Three hundred thirty-six consecutively recruited leukemic children treated according to different BFM protocol s ( PRED group , n = 280 , 60 mg/m(2 ) prednisone ; DEXA group , n = 56 , 10 mg/m(2 ) dexamethasone during induction therapy ) were studied . Study end point was the onset of symptomatic vascular accidents during induction therapy . Cumulative thromboembolism-free survival was significantly reduced in children in the PRED group ( thrombosis frequency , 10.4 % ) compared with children in the DEXA group ( thrombosis frequency , 1.8 % ; P = .028 ) . Although no significant difference was found in the overall prevalence of prothrombotic risk factors , 46.5 % of patients in the PRED group who experienced thromboembolic events were carriers of a prothrombotic risk factor , whereas no carrier in the DEXA group had a thromboembolism . At the time of maximum CASP activity , fibrinogen and activities of antithrombin , plasminogen , and protein S were significantly reduced in the PRED group . No significant correlation could be found between CASP activity and levels of coagulation factors . In conclusion , the use of dexamethasone instead of prednisone , administered with CASP , significantly reduced the onset of venous thromboembolism The Children 's Cancer Group enrolled 13 298 young people age < 21 years on 1 of 16 protocol s between 1983 and 2002 . Outcomes were examined in three time periods , 1983–1988 , 1989–1995 , 1996–2002 . Over the three intervals , 10-year event-free survival ( EFS ) for Rome/National Cancer Institute st and ard risk ( SR ) and higher risk ( HR ) B-precursor patients was 68 and 58 % , 77 and 63 % , and 78 and 67 % , respectively , whereas for SR and HR T-cell patients , EFS was 65 and 56 % , 78 and 68 % , and 70 and 72 % , respectively . Five-year EFS for infants was 36 , 38 , and 43 % , respectively . Seminal r and omized studies led to a number of important findings . Stronger post-induction intensification improved outcome for both SR and HR patients . With improved systemic therapy , additional intrathecal ( IT ) methotrexate effectively replaced cranial radiation . For SR patients receiving three-drug induction , iso-toxic substitution of dexamethasone for prednisone improved EFS . Pegylated asparaginase safely and effectively replaced native asparaginase . Thus , rational therapy modifications yielded better outcomes for both SR and HR patients . These trials provide the platforms for current Children 's Oncology Group trials Conventional therapy for childhood acute lymphoblastic leukemia ( ALL ) includes prednisone and oral 6-mercaptopurine . Prior observations suggested potential advantages for dexamethasone over prednisone and for intravenous ( IV ) over oral 6-mercaptopurine , which remain to be vali date d. We report the results of a r and omized trial of more than 1000 subjects that examined the efficacy of dexamethasone and IV 6-mercaptopurine .  Children with National Cancer Institute st and ard-risk ALL were r and omly assigned in a 2 x 2 factorial design to receive dexamethasone ( 6 mg/m(2)/d ) for 28 days in induction , plus taper , compared with prednisone ( 40 mg/m(2)/d ) . The second r and omized assignment was for daily oral or weekly IV 6-mercaptopurine during consolidation . During maintenance , 5 days of the r and omized steroid was given monthly , at the same dose , and all patients received daily oral 6-mercaptopurine . During delayed intensification , all patients received a dexamethasone dosage of 10 mg/m(2)/d for 21 days , with taper . Intrathecal ( IT ) methotrexate was the sole central nervous system-directed therapy . Patients r and omly assigned to receive dexamethasone had a 6-year isolated central nervous system-relapse rate of 3.7 % + /- 0.8 % , compared with 7.1 % + /- 1.1 % for prednisone ( P = .01 ) . There was also a trend toward fewer isolated bone marrow relapses with dexamethasone . The 6-year event-free survival ( EFS ) was 85 % + /- 2 % for dexamethasone and 77 % + /- 2 % for prednisone ( P = .002 ) . EFS was similar with oral or IV 6-mercaptopurine ; however , patients assigned to IV 6-mercaptopurine had decreased survival after relapse PURPOSE To evaluate whether dexamethasone ( DEXA ) yields a better outcome than prednisolone ( PRED ) in a prospect i ve , r and omized , controlled trial for the treatment of childhood acute lymphoblastic leukemia ( ALL ) . PATIENTS AND METHODS Two hundred thirty-one st and ard-risk ( SR ) patients and 128 intermediate-risk ( IR ) non-B-cell ALL patients were registered from March 
    Output:
    
There was no statistically significant difference in the risk of osteonecrosis , sepsis , fungal infection , diabetes or pancreatitis .
DEX in induction therapy for children with ALL  is more efficacious than PRED .
However , DEX is also associated with more toxicity , and currently it remains unclear whether short-term superiority of DEX will also result in better overall survival