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Published on: October 17, 2025
The outcome of chemotherapeutic regimen by high-risk pre-B-cell protocol in ALL children
Afshin Fathi1, Mehrdad Mirzarahimi1, Homa Far Ajkhah2
1Associate Professor in Pediatrics, Department of Pediatrics, School of Medicine, Ardabil University of Medical Sciences, Ardabil, Iran.
Insights
The Children Oncology Group (COG) protocol shows improved survival rates in high-risk acute lymphoblastic leukemia (ALL) children. Controlling infections is crucial for enhancing outcomes in pediatric ALL patients.
Area of Science:
- Pediatric Oncology
- Hematology
- Clinical Research
Background:
- Acute lymphoblastic leukemia (ALL) is a common childhood cancer.
- High-risk pre-B-cell ALL presents unique treatment challenges.
- Optimizing chemotherapeutic regimens is essential for improving pediatric ALL outcomes.
Purpose of the Study:
- To evaluate the effectiveness of the Children Oncology Group (COG) protocol for high-risk pre-B-cell ALL in children.
- To assess survival rates and relapse patterns in pediatric ALL patients treated with the COG protocol.
Main Methods:
- A cross-sectional study involving 55 children treated with the COG protocol from September 2010 to February 2015.
- Evaluation of chemotherapeutic regimen results, including recovery rates, survival, and relapse data.
Main Results:
- A complete recovery rate of 76.4% was observed within the first week of treatment.
- Three-year and five-year overall survival rates were 85.5% and 81%, respectively.
- The relapse rate after first remission was 20%, with a 50% mortality rate post-relapse. Sepsis was the cause of all deaths, particularly during the induction period.
Conclusions:
- The COG protocol demonstrates an increase in survival rates for pediatric ALL.
- Implementing the COG protocol and managing infections can significantly improve survival, irrespective of risk group.
- Infection control is a critical factor in reducing mortality during the induction phase of ALL treatment.
Objective:
The aim of this study was to investigate the outcome of chemotherapeutic regimen by high-risk pre-B-cell potocol in ALL children.
Methods:
The cross-sectional study was conducted on 55 children who were treated with the Children Oncology Group (COG) protocol from September 2010 to February 2015 to evaluate the chemotherapeutic regimen results.
Results:
There was a complete recovery rate of 76.4% during the first week after treatment. Three-year overall survival was 85.5% and five-year overall survival was 81%. Relapse rate after first remission was 20% and death after relapse was 50%. Thirty percent of total deaths were at the induction period. All of the deceased cases died due to sepsis.
Conclusion:
Results showed that the survival rate increased. By choosing the COG protocol and by controlling infection in patients without considering the risk group we can improve survival rates.
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