Vinca alkaloids are effective anticancer agents. Vindesine is a recent vinca alkaloid derivative with anti-tumor effects shown in in vitro systems and in patients with acute lymphocytic leukemia (ALL). The present study was designed to investigate the therapeutic effectiveness and toxicity of vindesine in combination with prednisone for remission induction in late stage ALL in children. Sixteen children with late-stage ALL were treated with vindesine 4.0 mg/m2/week intravenously and prednisone 60 mg/m2/day orally in four divided doses for minimum of three weeks. Thirteen children were evaluable. Of these patients, four had complete remission and four had partial response. Toxicity was well tolerated and consisted of bone pain, paresthesias, loss of deep tendon reflexes, leukopenia, and thrombocytopenia primarily. Abnormal liver function tests and fever were also noted in some patients. All patients had received vincristine and prednisone prior to vindesine prednisone combination. All patients had been resistant to vincristine prednisone combination prior to vindesine prednisone treatment. This study suggests effectiveness of vindesine in late stage ALL and lack of cross-resistance of vindesine and vincristine.