title: Acute lymphoblastic leukemia: A single center experience with Berlin, Frankfurt, and Munster-95 protocol.
abstract: BACKGROUND
  There is a paucity of data on the outcome following the treatment for acute lymphoblastic leukemia (ALL) from developing countries.
  
  
  METHODS
  Two hundred and thirty-eight consecutive patients with ALL <30 years of age diagnosed between January 2005 and December 2011 were analyzed retrospectively. Patients were treated modified Berlin, Frankfurt, and Munster 95 protocol. Event-free survival (EFS) was calculated using Kaplan-Meier survival analysis and variables were compared using log-rank test.
  
  
  RESULTS
  The EFS was 63.4% at a median follow-up was 32.7 months. On univariate analysis National Cancer Institute (NCI) risk stratification, sex, white blood cell count, day 8 blast clearance, and income were significantly associated with EFS. However, on multivariate analysis only female sex (P = 0.01) and day 8 blast clearance (P = 0.006) were significantly associated with EFS. Seventy-four of 238 (31%) patients had recurrent leukemia. The common sites of relapse were bone marrow in 55/74 (75%) patients and central nervous system in 11/74 (20%) patients.
  
  
  CONCLUSIONS
  Compared to western data, there was an increased proportion of NCI high-risk patients and T-cell immunophenotype in our study. There has been an improvement in outcome of patients with ALL at our center over the last 2 decades. Female sex and clearance of blast in peripheral blood by day 8 of induction was associated with better EFS.
authors.affiliation: Department of Medical Oncology, Cancer Institute (WIA), Adyar, Chennai, Tamil Nadu, India.
authors.forename: Venkatraman
authors.initials: V
authors.lastname: Radhakrishnan
authors.affiliation: Department of Medical Oncology, Cancer Institute (WIA), Adyar, Chennai, Tamil Nadu, India.
authors.forename: Sumant
authors.initials: S
authors.lastname: Gupta
authors.affiliation: Department of Medical Oncology, Cancer Institute (WIA), Adyar, Chennai, Tamil Nadu, India.
authors.forename: Prasanth
authors.initials: P
authors.lastname: Ganesan
authors.affiliation: Department of Medical Oncology, Cancer Institute (WIA), Adyar, Chennai, Tamil Nadu, India.
authors.forename: Rejiv
authors.initials: R
authors.lastname: Rajendranath
authors.affiliation: Department of Medical Oncology, Cancer Institute (WIA), Adyar, Chennai, Tamil Nadu, India.
authors.forename: Trivadi S
authors.initials: TS
authors.lastname: Ganesan
authors.affiliation: Department of Pathology, Cancer Institute (WIA), Adyar, Chennai, Tamil Nadu, India.
authors.forename: Kamalalayan Raghavan
authors.initials: KR
authors.lastname: Rajalekshmy
authors.affiliation: Department of Medical Oncology, Cancer Institute (WIA), Adyar, Chennai, Tamil Nadu, India.
authors.forename: Tenali Gnana
authors.initials: TG
authors.lastname: Sagar
keywords: Acute lymphoblastic leukemia; chemotherapy; survival
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