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Introduction: The overall survival in pediatric acute lymphoblastic leukemia (ALL) ranges from 45 to 81% in India. Aggressive chemotherapy protocols like MCP841 have improved the outcome and it can be delivered with minimal supportive care. This study retrospectively analyses the clinical profile and overall survival of patients treated by this protocol. Objective: This single-center study aims to estimate the event-free survival of patients treated accordingly to the MCP841 protocol with high-dose cytarabine (HDAC) at 2 g/m 2 as the backbone, along with the risk-stratified incidence and cause of mortality in childhood ALL. Material and Methods: Records of 156 patients aged 1 to 19 years, newly diagnosed with ALL from June 2009 to August 2013 who were treated according to the forementioned protocol were analyzed. Risk stratification for both precursor B-cell ALL (B-ALL) and T-cell ALL (T-ALL) was done, followed by an analysis of the correlation of risk-stratified groups with mortality and survival outcomes. Result: Precursor B-ALL was found in 70% patients (including 69.7% [ n = 76] standard risk, 20.1% [ n = 22] intermediate risk, and 10% [ n = 11] high risk), while 30% had T-ALL (including 74.4% [ n = 35] standard risk and 25.5% [ n = 12] high risk). Death during induction occurred in 0.04% (n = 5) precursor B-ALL and 23% (n = 11) T-ALL patients. The causes were infection in 62.5%, hemorrhage in 25%, and cortical venous thrombosis in 12.5%. Among those who attained remission (89.7%, n =140), relapse occurred in 26% (n = 27) precursor B-ALL and 28% (n = 10) T-ALL patients. Approximately 31% patients died in the postinduction phase, with progressive disease due to relapse being the most common cause and bone marrow the most common site. Event-free survival at 168 months for overall population, precursor B-ALL, and T-ALL was 59, 62.4, and 51.1%, respectively. Conclusion: A comparable survival outcome in par with similar centers in developing countries with the MCP841 protocol was found. Infections are a major cause of mortality during treatment, especially when associated with malnourishment. Relapsed disease and poor salvage rates remain a major hurdle to achieving better survival in developing countries; however, better supportive care and infection control measures along with implementing risk-stratified high-dose chemotherapy protocols might improve outcome in the future. [ABSTRACT FROM AUTHOR]

Background: To assess the association between Neutrophil-to-lymphocyte ratio (NLR) and Platelet-to-lymphocyte ratio (PLR) with a degree of activity of paediatric systemic lupus erythematosus (pSLE) in terms of Systemic Lupus Erythematosus Disease Activity Index (SLEDAI-2K) score., Methods: This observational cross-sectional study was conducted in Paediatric Rheumatology Clinic, Medical College Kolkata. Systemic lupus erythematosus was diagnosed in children based on the 2019 EULAR/ACR criteria and/or SLICC 2012 criteria. A total of 31 children were included in the study whereas patients with chronic illnesses were excluded., Results: The mean age of presentation was 6.87 years among 31 children with pSLE. The most common presenting feature is prolonged fever and pallor followed by renal involvement. Most of the children presented with active disease 24 (77.42%). The mean NLR and PLR ratios were 4.29 ± 2.45 (0.9 - 10.57) and 112.26 ± 45.08 (47.7 - 203.9) respectively. The average SLEDAI-2K score was 15.9 (± 7.33). The NLR ratio in children with active disease (SLEDAI-2K score > 6) was 4.68 ± 2.44 (1.54 - 10.57) and inactive disease (SLEDAI-2K score <6) was 2.94 ± 2.10 (0.9 - 5.7) with p 0.0002. The PLR ratio in children with the active and inactive disease was 125.91 ± 41.29 (54.2 - 203.9) and 65.45 ± 18.0 (47.7 - 91.2) respectively (p 0.008)., Conclusion: The NLR and PLR ratio might be utilised as a trusted and cost-effective tool in the evaluation and prediction of pSLE disease activity., Competing Interests: The authors declare no conflicts of interest., (© The Author(s).)