This presentation is an analysis of front-end prognostic variables in achieving a complete response, a continuous complete remission, and disease-free survival in pediatric acute lymphoblastic leukemia at the Cancer Institute, Madras, India between 1983 and 1988. The clinical characteristics at presentation showed that virtually 100% of patients belong to the poor risk category, age < 3 years of > 6 years 72.2%, WBC > 10,000/mm3 59.8%, blast count > 50% 39.2%, organomegaly 91.8%, and L2 morphology 66.0%. All patients had more than one risk factor. Between 1983 and 1988, 97 children were treated on a pilot protocol designed in collaboration with the Lymphoma Biology Division of the Pediatric Oncology Branch of the National Cancer Institute, Bethesda, Maryland. The protocol was designed for a poor prognostic group. The significance of implicated poor prognostic factors was analyzed using the Cox proportional hazard model. Age at presentation was the only variable that emerged as an independent risk factor, and sex appeared to be a modifier. No other variables attained significance. Survival data were calculated by the Kaplan-Meier method. The relapse-free and event-free survivals up to 10 years were 50.7% and 38.1%, and compare reasonably well with results reported for similar groups elsewhere for the same period.