Childhood acute lymphoblastic leukemia in India: an approach to management in a three-tier society.

Within a population of 882 million, six thousand children will develop acute lymphoblastic leukemia each year in India. These children come from three socio-economic backgrounds: Profile I (70%) being extremely poor who cannot afford any treatment unless it is provided free, Profile II (25%) from the middle class, and Profile III (5%) who can afford to have the best possible treatment. Current protocols for childhood ALL range from simple low-cost regimes like UKALL VIII, intermediate intensity regimes like BFM 76/79, and aggressive regimes aimed at increasing cure rates in the high risk groups. Since state resources are limited, the pediatric oncologist in India has to decide on the appropriate treatment protocol for the individual child in each of these profiles. This paper suggests an approach to managing childhood ALL in developing countries like India.