Acute lymphoblastic leukemia in India: An analysis of prognostic factors using a single treatment regimen

Summary Background: In the past, treatment results in Indian children with ALL have been poor, primarily due to inadequate chemotherapy and supportive care, but perhaps reflecting differences from Western countries in the pattern of subtypes. In an attempt to improve survival, we have used a more intensive treatment protocol, MCP841, and examined prognostic factors. Patients and methods: Five hundred thirty previously untreated patients 60,000 per mm 3 and Hb 6 gm/dl or above (48% EFS); and 3) WBC > 60,000 per mm 3 and Hb below 6 gm/dl (16% EFS). In a multivariate model, only WBC, Hb and lymphadenopathy were significantly associated with EFS (P < 0.01). Conclusions: The CR and EFS rates achieved represent a significant improvement over previous results at this institution. Bulky extramedullary disease was an important risk factor in this series, but age and WBC alone inadequately defined risk groups, suggesting that prognostic factors may vary in different world regions.