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.