title: Treatment of children with acute lymphoblastic leukemia in India using a BFM protocol.
abstract: BACKGROUND
  Limited data exists on the long-term treatment outcome and prognosis of childhood ALL in India.
  
  
  METHODS
  Three hundred and seven children (1-14 years) with acute lymphoblastic leukemia (ALL) were treated with a modified BFM protocol 76/79 between 1985 and 2003. Treatment outcome and prognostic factors were evaluated.
  
  
  RESULTS
  The median age was 6 years; 78% had B lineage acute lymphoblastic leukemia and 22% had T lineage disease. Good prednisolone response was observed in 82% of cases. Two hundred and seventy-three children (91.6%) achieved complete remission; with 2% induction-related mortality and 6.4% having resistant disease. 52% of all evaluable patients and 56.8% of complete responders are in continuous complete remission (CCR) at a median follow up of 62 months (30-194 months). The median event free survival (EFS) was 114 months. The estimated 5 year overall survival, EFS and disease free survival was 59.8%, 56%, and 53.9%, respectively. The prognostic factors adversely affecting the EFS were poor prednisolone response, resistant disease and WBC count greater than 20 x 10(9)/L at diagnosis. The 5 year EFS in the favorable risk group (age 1-9 years, WBC count less than 20 x 10(9)/L and prednisolone good response) was 73.1 +/- 4.9%.
  
  
  CONCLUSIONS
  This report examines a cohort of children with ALL treated with a BFM protocol in India with adequate follow up and demonstrates the need for cost effective improvements.
authors.affiliation: Department of Haematology, Christian Medical College, Vellore, Tamil Nadu 632004, India.
authors.forename: Ashish
authors.initials: A
authors.lastname: Bajel
authors.forename: Biju
authors.initials: B
authors.lastname: George
authors.forename: Vikram
authors.initials: V
authors.lastname: Mathews
authors.forename: Auro
authors.initials: A
authors.lastname: Viswabandya
authors.forename: M L
authors.initials: ML
authors.lastname: Kavitha
authors.forename: Alok
authors.initials: A
authors.lastname: Srivastava
authors.forename: Mammen
authors.initials: M
authors.lastname: Chandy
mesh_terms: D000293:Adolescent; D000970:Antineoplastic Agents / Q000008:administration & dosage; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007194:India; D007223:Infant; D053208:Kaplan-Meier Estimate; D008297:Male; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000188:drug therapy* / Q000401:mortality; D011239:Prednisolone / Q000008:administration & dosage; D011379:Prognosis
chemical_list: D000970:Antineoplastic Agents; D011239:Prednisolone