First Line Therapy:
Amongst the thirty-one treatment naïve patients risk-stratified first-line therapy,three of whom were stratified as Low- Risk (LR) precursor B-Cell ALL were treated with CCG1891 protocol prior to 2008, which is a 3-drug induction regimen that involves prednisone, VCR (vincristine) L -asparaginase, PVA and CNS-directed consolidation therapy with and two delayed intensification phases. Ten patients categorised as High-Risk (HR) received chemotherapy-regimen that is based on the CCG 1882 protocols that involves 4-drug induction regimen i.e., prednisone, VCR (vincristine), L -asparaginase, PVDA and daunomycin. Chemotherapy regimen for HR patients involved a more intensive consolidation and a single-delayed phase of intensification and intensified intrathecal therapy was given to patients who did not receive cranial radiation therapy, and prophylactic cranial radiation therapy was administered to older children (aged > 10 years) without CNS disease , while cranio-spinal radiation was administered in patients with CNS-disease. In the two patients diagnosed and stratified as Very High-Risk (VHR) and T-Cell ALL were treated with St.Jude Total XIII B HR protocol. However, from 2008 onwards the chemotherapy regimens changes were in-line with the risk-stratification that took into account the RUNX1-ETV6 translocation in the Lower Risk (LR) category and additional treatment intensification based on the intensified CCG 1900 series: Five LR patients were treated with CCG1991 chemotherapy regimen , while Six HR patients treated with CCG1961 chemotherapy regimen and Five HR patients were treated with COG 0232 chemotherapy protocol that involved a 4-drug regimen, i.e., Cytarabine, VCR, Daunorubicin, Peg-asparaginase, Prednisolone with prolonged induction therapy administered to patients with M2 or M1 disease status with >1% minimal residual disease. There were three patients diagnosed as T cell ALL and treated with the St. Jude Total XIII B HR regimen.