Resource limited centres can deliver treatment for children with acute lymphoblastic leukaemia with risk-stratified minimal residual diseasebased UKALL 2003 protocol with no modification with a good outcome.

OBJECTIVES Acute Lymphoblastic Leukaemia (ALL) is the most common malignancy in children. With improved supportive care and a better understanding of the disease biology, it is now a curablecancerin the developed world. However,in low-income countries the cure rate remains relatively poor(estimated at around 60%). We report our single centre experience on the survival of children with ALL treated on the MRD-based risk-stratified UKALL 2003 protocol, from a centre in South India. METHODS All consecutive children diagnosed with ALL between year 2013 to 2019 were included in this retrospective study. Allchildren received uniform treatment as per the UKALL 2003 protocolbased on NCI risk and post-induction MRD status. All the detailsincluding the type of leukaemia, NCI risk status, date of diagnosis, treatment start date, the treatment arm of the protocol, Post induction MRD status, cytogenetics, molecular genetics, and complications werecaptured.Analysis was done using prism GraphPad version 8.0. RESULTS A total of 107 children were started on treatment during this period.The majority of them were boys (68/107).Fifty-nine of them were NCI standard risk(55%). B-ALL was the most common type(92%).Total 56/107(52.3%) children received treatment under the government's insurance scheme for low-income bracket. All achieved morphological remission at the end of induction. The day 29 post-induction MRD on flow cytometry was performed in 95/107 children. It was > 0.01% in 22% (21/95) of children.A total of five (4.7%) children relapsed so farwith a mean follow up of 27 months from the diagnosis. There were 17 deaths(15.9%) out of 107 treated. The OS and EFS at 3years was85% (95% CI 75 to 92%). CONCLUSION It is feasible to follow and deliver chemotherapy as per the UKALL2003 protocol without any modifications in resource-limited setting.The survival rates have significantly improved over the years in our centre from 5 yr. EFSof 60% in 2010and now to3 year EFS of 85%. It is important to note that there was no treatment abandonment in our cohort.