To Evaluate a) the Effectiveness of Immature Reticulocyte Fraction (IRF) as Earliest Predictor of Bone Marrow Regeneration & b) To Test MRD as Strongest Predictor of Relapse in Pediatric Acute Leukemia's in Remission Induction Phase

Background Leukaemia is the most common childhood malignancy accounting for 30 % of all cancers. Chemotherapy is the main stay of treatment in acute leukemias & it should be monitored by IRF & presence of blasts in bone marrow (MRD). Methodology Induction remission phase of chemotherapy shows IRF on sysmex= (8.3 1.7) % & ANC = ( 0.48 0.09) x109/L on 14th day & (1.4 0.06) x109/L on 29th day.10 % leukemia cases with IRF less than 5 % & MRD greater than 0.01 % on 14th day & blasts in CSF & bone marrow on 29th day showed relapse. Conclusion Post chemotherapy, IRF is the earliest indicator of haematopoietic recovery in bone marrow much earlier than ANC. The MRD greater than 0.01 % in the remission induction phase on day 29 is the strongest prognostic indicator superior to other commonly used prognostic markers in childhood leukemias and predicts both the early and late relapses. This early laboratory indicator will guide the clinicians to make important therapeutic decisions, which will be economic and life saving for the patients