Berlin-Frankfurt-Münster (BFM) risk groups

Source: Childhood Acute Lymphoblastic Leukemia Treatment (PDQ®)–Health Professional Version, National Cancer Institute.

Source updated: April 21, 2025 · Captured 2026-09-09.

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Context: Risk-Based Treatment Assignment / Prognostic (Risk) Groups

Since 2000, risk stratification on BFM protocols has been based on treatment response criteria, as well as biology. Treatment response is assessed primarily via MRD measurements at two time points, EOI (time point 1, week 5) and end of the IB phase (similar to COG consolidation phase) at week 12 (time point 2). High MRD at both time points is defined as higher than 5 × 10-4.

The BFM defines 3 risk groups based on early response:[135]

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Standard risk: Patients who have negative MRD at both time points.

Intermediate risk: Patients who have high MRD at time point 1 and negative MRD at time point 2.

High risk: Patients with high MRD at time point 2. Patients with T-ALL with a poor response to the prednisone prophase are also considered high risk, regardless of subsequent MRD.

Biological factors used to stratify patients as high risk (regardless of MRD at either time point) include KMT2A::AFF1, TCF3::HLF, and hypodiploidy (<45 chromosomes). Patients with IKZF1-plus status (IKZF1 deletions that co-occurred with deletions in CDKN2A, CDKN2B, PAX5, or PAR1 in the absence of ERG deletion) [166] are considered high risk if they have high MRD at EOI, regardless of EOC MRD. Age, presenting leukocyte count, and CNS status at diagnosis do not factor into the current risk classification schema.

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