title: Outcome of childhood acute Lymphoblastic leukemia in Egyptian children: a challenge for limited health resource countries.
abstract: In childhood acute lymphoblastic leukemia (ALL) the reported 5-year event-free survival (EFS) rates are as high as 80%. Since 2004, multiple Egyptian centers shifted protocol of therapy of ALL to the CCG 1991 (the single delayed intensification arm) and CCG 1961 protocol for standard risk and high-risk ALL therapy, respectively, being cost effective. We aimed to evaluate the efficacy and safety of the CCG protocol in treatment of childhood ALL in Ain Shams and Menoufeya University hospitals.
  
  
  METHODS
  Fifty-two ALL patients, aged 1-17 years, treated according to the modified CCG protocol in both centers and registered from November 2004 to December 2005 were included. They were classified into three risk groups, standard risk (SR), high-risk standard arm (HR-SA), and high-risk augmented arm (HR-AA).
  
  
  RESULTS
  The mean age at diagnosis was 5.9 + 3.3 years, male/female ratio of 1.6:1, and central nervous system leukemia represented 6%. The 5-year overall survival (OS) and EFS were 84.6% and 67%, respectively. The 5-year OS and EFS were 92.6% and 70% in SR, 68.8% and 55% in HR-SA, 88.9% and 80% in HR-AA patients, respectively. Six patients had grade 3-4 adverse events.
  
  
  CONCLUSIONS
  The outcome of HR-SA protocol was inferior to the other two groups, necessitating shift to a more intensified arm with double delayed intensification. The use of minimal residual disease for better risk classification of childhood ALL is recommended in our centers.
authors: Pediatric Department-Hematology/Oncology Unit, Ain Shams University, Cairo, Egypt. aagtfz@gmail.com
authors: Azza A G
authors: AA
authors: Tantawy
authors: Farida H
authors: FH
authors: El-Rashidy
authors: Iman A
authors: IA
authors: Ragab
authors: Osama A
authors: OA
authors: Ramadan
authors: Maha M
authors: MM
authors: El-Gaafary
mesh_terms: D000293:Adolescent; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D018572:Disease-Free Survival; D004534:Egypt; D005260:Female; D005500:Follow-Up Studies; D006295:Health Resources; D006801:Humans; D007223:Infant; D008297:Male; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000188:drug therapy*; D011446:Prospective Studies; D012307:Risk Factors; D015996:Survival Rate; D016896:Treatment Outcome