Calculators & Tools

ALL — NCI/Rome Risk & Toronto Stage

Acute lymphoblastic leukaemia: NCI risk group plus Toronto CNS-based stage.

1 What is the ALL — NCI/Rome Risk & Toronto Stage?

The ALL — NCI/Rome Risk & Toronto Stage is a oncology scoring tool used in paediatric practice. Acute lymphoblastic leukaemia: NCI risk group plus Toronto CNS-based stage. It scores 3 criteria and interprets the total across 4 bands, so the number always arrives with the severity it implies rather than on its own. In PediAid each criterion is shown as a labelled option with the weight it carries, so the total can be checked rather than taken on trust.

2 When to use it

  • Grading severity at the bedside in oncology
  • Recording an objective severity band in the case notes
  • Deciding when a total crosses the threshold for escalation
  • Re-scoring to track whether a child is improving or deteriorating
  • Checking the exact criteria of a score used infrequently

3 Formula & method

The score sums 3 criteria: Age at diagnosis; Presenting white cell count; CNS status (Toronto stage). Totals are then banded: any score - Standard risk · Stage I: nCI standard risk (age 1-9.99 y AND WBC <50 000) with no CNS disease - Toronto Stage I. Best prognosis; standard-intensity therapy; 1 risk point or more - Standard risk · CNS involvement: nCI standard risk but with CNS blasts - Toronto Stage II. Intensified CNS-directed therapy required; 2 risk points or more - High risk: nCI high risk (age <1 or ≥10 years, or WBC ≥50 000). Augmented therapy; check cytogenetics and MRD response; 3 risk points or more - High risk · CNS involvement: nCI high risk with CNS disease - Toronto Stage II. Most intensive therapy including CNS-directed treatment; MRD-guided escalation.
  • Toronto Tier-1 stage for ALL: Stage I = no CNS disease (CNS1/CNS2); Stage II = CNS disease (CNS3).
  • NCI/Rome criteria: standard risk requires BOTH age 1-9.99 years and WBC <50 000/µL.
  • Source (risk): Smith M et al. Uniform approach to risk classification and treatment assignment for children with ALL. J Clin Oncol 1996;14:18-24. Source: Gupta S, Aitken JF, Bartels U et al. Paediatric cancer stage in population-based cancer registries: the Toronto consensus principles and guidelines. Lancet Oncol 2016;17:e163-72.

4 Frequently asked questions

How many criteria does the ALL — NCI/Rome Risk & Toronto Stage use?

3. They are Age at diagnosis; Presenting white cell count; CNS status (Toronto stage).

What do the bands of the ALL — NCI/Rome Risk & Toronto Stage mean?

The total is interpreted as: any score - Standard risk · Stage I: nCI standard risk (age 1-9.99 y AND WBC <50 000) with no CNS disease - Toronto Stage I. Best prognosis; standard-intensity therapy; 1 risk point or more - Standard risk · CNS involvement: nCI standard risk but with CNS blasts - Toronto Stage II. Intensified CNS-directed therapy required; 2 risk points or more - High risk: nCI high risk (age <1 or ≥10 years, or WBC ≥50 000). Augmented therapy; check cytogenetics and MRD response; 3 risk points or more - High risk · CNS involvement: nCI high risk with CNS disease - Toronto Stage II. Most intensive therapy including CNS-directed treatment; MRD-guided escalation.

Does the score replace clinical judgement?

No. It is a structured way to record and communicate severity. A clinician concerned about a child should act on that concern regardless of the total.

Where does this score come from?

Toronto Tier-1 stage for ALL: Stage I = no CNS disease (CNS1/CNS2); Stage II = CNS disease (CNS3).

Does it work offline?

Yes. Score definitions are bundled with the PediAid app, so the score computes without a connection.

For qualified clinicians. This page and the PediAid app are a clinical aid only. Calculations and reference data must be verified against the patient's clinical context, the source guideline and your local protocols before any treatment decision is made.