Outcomes With Risk-stratified Treatment Algorithm for Childhood ALL in India

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Maddukuri Sriram1, Sneha Bhosle, Amita Mahajan

  • 1Department of Paediatric Haematology Oncology, Indraprastha Apollo Hospital, New Delhi, India.

Journal of Pediatric Hematology/Oncology
|November 6, 2025
PubMed

Insights

Risk-stratified management effectively reduces treatment intensity for standard-risk (SR) patients with acute lymphoblastic leukemia (ALL). This approach minimizes treatment-related mortality (TRM), proving beneficial even in resource-limited settings.

Area of Science:

  • Pediatric Oncology
  • Hematology
  • Clinical Research

Background:

  • Risk-stratified management is crucial for optimizing acute lymphoblastic leukemia (ALL) treatment.
  • Reducing treatment intensity for standard-risk (SR) patients is vital to minimize treatment-related mortality (TRM), especially in low-middle-income countries.
  • Effective management strategies are needed to improve outcomes while reducing treatment burdens.

Purpose of the Study:

  • To evaluate the efficacy of a risk-stratified, response-adapted algorithm in managing ALL patients.
  • To assess overall survival (OS) and event-free survival (EFS) in a cohort of ALL patients.
  • To determine the induction treatment-related mortality (TRM) within the study cohort, particularly in the SR group.

Main Methods:

  • Analysis of 410 consecutive ALL patients treated with a risk-stratified, response-adapted algorithm.
  • Long-term follow-up to assess survival outcomes (OS and EFS).
  • Evaluation of induction TRM, with a specific focus on SR patients.

Main Results:

  • The overall cohort achieved a 5-year OS of 84.1% and EFS of 81.9%.
  • The SR group demonstrated excellent outcomes with a 5-year OS of 91.6% and EFS of 88.5%.
  • Induction TRM was low at 1.7% for the entire cohort, with no TRM observed in the SR group.

Conclusions:

  • Risk-stratified management with reduced treatment intensity is effective for SR ALL patients.
  • This strategy significantly lowers TRM, making it suitable for resource-limited settings.
  • The findings support the implementation of tailored treatment algorithms to improve ALL patient outcomes.

Keywords:
Indiachildhood ALLlow-middle-income countryoutcomestreatment-related mortality

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