by Mike Addelman,University of Manchester

Credit: Pixabay/CC0 Public Domain

A landmark Indian clinical trial has found that giving steroids in short bursts instead of continuously can halve early treatment-related deaths in children with leukemia without reducing their chances of being cured. The study led by the Indian Childhood Collaborative Leukemia (ICiCle) group, which includes University of Manchester researchers, treated over 3,000 children with acute B-cell precursor acute lymphoblastic leukemia (ALL) at six major centers across India.

ALL is a fast-growing blood cancer that starts from very early B-cells in the bone marrow. It is the most common form of ALL, especially in children.

Published inThe Lancet Regional Health—Southeast Asia, the researchers compared the standard four-week continuous steroid course with a pulsed schedule given in weeks one, two and four.

Children on the pulsed schedule had far fewer early deaths, with rates falling from 3.5% to 1.3%.

Most leukemia-related early deaths are currently caused by severe infections linked to continuous steroid use—a major challenge in low- and middle-income countries.

Crucially, the shorter steroid exposure did not affect how well treatment worked, with remission rates of around 98% in both groups.

Survival outcomes were also similar, showing that the safer approach does not compromise cure.

The trial also found that using a powerful and highly effective class of chemotherapy drugs calledanthracyclinesearly in treatment increased the risk of treatment-related deaths.

The findings come from the ICiCle-ALL-14 trial, the first multicenter randomized pediatric oncology trial conducted in India.

Childhood leukemia now has survival rates above 90% in many wealthy countries.

But children in low- and middle-income countries still face far higher risks of dying during treatment, often because infections strike early on.

Since 2013, the ICiCle group team has been working to bring a consistent, modern treatment approach to children with leukemia across India, rolled out to centers across India.

Professor Vaskar Saha from The University of Manchester and Tata Medical Center, is lead author and founder of the ICiCle group.

He said, "We show for the first time that a simple change in how we give steroids can save lives. By reducing continuous exposure, we appear to lessen the risk of severe infections without compromising the effectiveness of treatment. This is a practical, low-cost intervention that could be adopted widely, particularly in settings where treatment-related mortality remains high."

Professor Venkatraman Radhakrishnan of the Cancer Institute (WIA) said, "The study provides robust randomized evidence that steroid scheduling itself is a modifiable determinant of induction mortality. The lack of any detriment in MRD response or survival makes this a particularly compelling practice change."

More information The Lancet Regional Health—Southeast Asia (2026)