{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T13:56:45Z","timestamp":1790776605895,"version":"4.1.0"},"reference-count":18,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"2","license":[{"start":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T00:00:00Z","timestamp":1775001600000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2026,4]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>While the survival of childhood acute lymphoblastic leukemia (ALL) approaches 90% in developed nations, outcomes in developing countries are much lower.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>We conducted a retrospective analysis of the first 50 patients aged &lt;25 years with newly diagnosed ALL who were treated with a modified Berlin\u2013Frankfurt\u2013M\u00fcnster (BFM)-2009 protocol at our tertiary care government hospital between May 2020 and December 2024. All patients were followed up until December 2025.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>The use of a modified risk-adapted Western protocol was feasible in a government hospital setting without undue toxicity or mortality.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.4103\/ijc.ijc_244_26","type":"journal-article","created":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T10:21:24Z","timestamp":1788949284000},"page":"153-159","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["Outcomes of acute lymphoblastic leukemia in children and young adults treated with a Berlin\u2013Frankfurt\u2013M\u00fcnster-based protocol in a tertiary care multispecialty government hospital"],"prefix":"10.4103","volume":"63","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7025-7552","authenticated-orcid":false,"given":"Anupama S.","family":"Borker","sequence":"first","affiliation":[{"name":"Department of Medical Oncology, Goa Medical College and Hospital, Bambolim, Goa, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-5061-0298","authenticated-orcid":false,"given":"Darshan J","family":"Kanani","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Goa Medical College and Hospital, Bambolim, Goa, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2026,9,8]]},"reference":[{"key":"R1-20260930","doi-asserted-by":"crossref","first-page":"2938","DOI":"10.1200\/JCO.2014.59.1636","article-title":"Childhood acute lymphoblastic leukemia: Progress through collaboration","volume":"33","author":"Pui","year":"2015","journal-title":"J Clin Oncol"},{"key":"R2-20260930","doi-asserted-by":"crossref","first-page":"1663","DOI":"10.1200\/JCO.2011.37.8018","article-title":"Improved survival for children and adolescents with acute lymphoblastic leukemia between 1990 and 2005: A report from the children\u2019s oncology group","volume":"30","author":"Hunger","year":"2012","journal-title":"J Clin Oncol"},{"key":"R3-20260930","doi-asserted-by":"crossref","first-page":"167","DOI":"10.1023\/A:1008366814109","article-title":"Acute lymphoblastic leukemia in India: An analysis of prognostic factors using a single treatment regimen","volume":"10","author":"Advani","year":"1999","journal-title":"Ann Oncol"},{"key":"R4-20260930","doi-asserted-by":"crossref","first-page":"1570","DOI":"10.1016\/j.ejca.2004.11.004","article-title":"Treatment of acute lymphoblastic leukaemia in countries with limited resources; lessons from use of a single protocol in India over a twenty year peroid","volume":"41","author":"Magrath","year":"2005","journal-title":"Eur J Cancer"},{"issue":"18_Suppl","key":"R5-20260930","doi-asserted-by":"crossref","first-page":"20015","DOI":"10.1200\/jco.2007.25.18_suppl.20015","article-title":"Result of childhood acute lymphoblastic leukemia protocol (INCTR) from a developing country","volume":"25","author":"Mukhopadhyay","year":"2007","journal-title":"J Clin Oncol"},{"key":"R6-20260930","doi-asserted-by":"crossref","first-page":"621","DOI":"10.1002\/pbc.21671","article-title":"Treatment of children with acute lymphoblastic leukemia in India using a BFM protocol","volume":"51","author":"Bajel","year":"2008","journal-title":"Pediatr Blood Cancer"},{"key":"R7-20260930","doi-asserted-by":"crossref","first-page":"168","DOI":"10.1002\/pbc.21897","article-title":"Survival outcome in childhood ALL: Experience from a tertiary care centre in North India","volume":"53","author":"Kulkarni","year":"2009","journal-title":"Pediatr Blood Cancer"},{"key":"R8-20260930","doi-asserted-by":"crossref","first-page":"785","DOI":"10.1007\/s13312-011-0129-3","article-title":"Childhood T-lineage acute lymphoblastic leukemia: Management and outcome at a tertiary care center in North India","volume":"48","author":"Arya","year":"2011","journal-title":"Indian Pediatr"},{"key":"R9-20260930","doi-asserted-by":"crossref","first-page":"261","DOI":"10.4103\/0971-5851.171552","article-title":"Acute lymphoblastic leukemia: A single center experience with Berlin, Frankfurt, and Munster-95 protocol","volume":"36","author":"Radhakrishnan","year":"2015","journal-title":"Indian J Med Paediatr Oncol"},{"key":"R10-20260930","doi-asserted-by":"crossref","first-page":"5118","DOI":"10.1182\/blood-2019-127985","article-title":"Encouraging results with ALL IC-BFM 2009 protocol therapy in pediatric acute lymphoblastic leukemia\/lymphoma in resource-limited setting: A single-center study from India","volume":"134","author":"Nath","year":"2019","journal-title":"Blood"},{"key":"R11-20260930","doi-asserted-by":"crossref","first-page":"218","DOI":"10.1016\/j.phoj.2023.10.001","article-title":"Treatment of newly diagnosed paediatric acute lymphoblastic leukaemia on BFM-based chemotherapy protocol: Feasibility and outcome from a tertiary care center in India","volume":"8","author":"Khandelwal","year":"2023","journal-title":"Pediatr Hematol Oncol J"},{"key":"R12-20260930","doi-asserted-by":"crossref","first-page":"494","DOI":"10.1007\/s12288-024-01898-5","article-title":"Outcome of childhood and adolescents and young adults ALL treated with ALL IC-BFM 2009 protocol-A single-center experience in India","volume":"41","author":"Kumar","year":"2025","journal-title":"Indian J Hematol Blood Transfus"},{"key":"R13-20260930","doi-asserted-by":"crossref","first-page":"2439733","DOI":"10.1080\/16078454.2024.2439733","article-title":"Treatment of pediatric acute lymphoblastic leukemia in India as per modified BFM 95 protocol with minimal residual disease monitoring","volume":"30","author":"Thakkar","year":"2025","journal-title":"Hematology"},{"key":"R14-20260930","doi-asserted-by":"crossref","first-page":"40","DOI":"10.1097\/MPH.0000000000003136","article-title":"Outcomes with risk-stratified treatment algorithm for childhood ALL in India","volume":"48","author":"Sriram","year":"2026","journal-title":"J Pediatr Hematol Oncol"},{"key":"R15-20260930","doi-asserted-by":"crossref","DOI":"10.1007\/s13312-026-00277-9","article-title":"Outcomes of childhood acute lymphoblastic leukemia treated with modified BFM-2009 protocol using measurable residual disease-based risk-stratification: A single-center study","author":"Khera","year":"2026","journal-title":"Indian Pediatr"},{"key":"R17-20260930","doi-asserted-by":"crossref","first-page":"3499","DOI":"10.1200\/JCO.22.01760","article-title":"Childhood Acute Lymphoblastic Leukemia: Results of the Randomized Acute Lymphoblastic Leukemia Intercontinental-Berlin-Frankfurt-M\u00fcnster 2009 Trial","volume":"41","author":"Campbell","year":"2023","journal-title":"J Clin Oncol"},{"key":"R18-20260930","doi-asserted-by":"crossref","first-page":"215","DOI":"10.4103\/ijc.ijc_355_21","article-title":"ALL induction outcome: Real-world data from a pediatric oncology center in an LMIC setup with rural predominance","volume":"61","author":"Sampagar","year":"2024","journal-title":"Indian J Cancer"},{"key":"R21-20260930","doi-asserted-by":"crossref","first-page":"4646","DOI":"10.18203\/2394-6040.ijcmph20253266","article-title":"Incidence and trends of cancer in Goa, India: A single center retrospective study","volume":"12","author":"Nayak","year":"2025","journal-title":"Int J Community Med Public Health"}],"container-title":["Indian Journal of Cancer"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.4103\/ijc.ijc_244_26","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T13:05:11Z","timestamp":1790773511000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.4103\/ijc.ijc_244_26"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4]]},"references-count":18,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2026]]}},"URL":"https:\/\/doi.org\/10.4103\/ijc.ijc_244_26","relation":{},"ISSN":["0019-509X","1998-4774"],"issn-type":[{"value":"0019-509X","type":"print"},{"value":"1998-4774","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4]]},"assertion":[{"value":"2026-04-16","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-06-16","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}