Outcomes of acute lymphoblastic leukemia in children and young adults treated with a Berlin-Frankfurt-Münste-based protocol in a tertiary care multispecialty government hospital

BACKGROUND: While the survival of childhood acute lymphoblastic leukemia (ALL) approaches 90% in developed nations, outcomes in developing countries are much lower. METHODS: We conducted a retrospective analysis of the first 50 patients aged <25 years with newly diagnosed ALL who were treated with a modified Berlin-Frankfurt-Münster (BFM)-2009 protocol at our tertiary care government hospital between May 2020 and December 2024. All patients were followed up until December 2025. RESULTS: The median age was 6 years with a male-to-female ratio of 1.5:1. Thirty-six patients had pre-B-cell ALL and 14 had T-cell ALL. On day 8, seven patients (14%) had poor prednisone response and 43 (86%) had good prednisone response. The complete remission rate at the end of induction was 94%. Forty-three patients (86%) achieved measurable residual disease negative status. According to BFM-2009 stratification, 12 were standard risk (SR), 30 were intermediate risk (IR), and 8 were high risk (HR). One patient abandoned treatment, seven patients relapsed, and three died of treatment-related toxicity. At 3 years, the event-free survival (EFS) and overall survival for the entire cohort were 75.2% and 78.3%, respectively. The SR, IR, and HR groups achieved an EFS of 90.0%, 73.3%, and 62.5%, respectively, at 3 years. CONCLUSION: The use of a modified risk-adapted Western protocol was feasible in a government hospital setting without undue toxicity or mortality.