Efficacy and safety of three-drug induction-based MASPORE 2003 chemotherapy protocol in standard- and intermediate-risk pediatric acute lymphoblastic leukemia: a decade-long single-center experience from India.

Acute lymphoblastic leukemia (ALL), the most common childhood cancer, shows >90% survival in high-income settings but poorer outcomes in low- and middle-income regions due to increased infection rates, toxicity, and treatment abandonment. This single-center retrospective study from January 2016 to June 2025, analyzed outcomes of pediatric ALL patients treated with MASPORE 2003 protocol. Among 164 children, 137 met inclusion criteria. Relapse was observed in 8.76%, with treatment-related mortality of 2.91%. Among patients with ≥2 years follow-up (n = 118), OS and EFS were 92.7% and 87.2%, respectively. The protocol's anthracycline-free induction and reduced-intensity reinduction achieved favorable survival with lower toxicity and treatment abandonment in a LMIC.