Treatment in TAM cases is indicated only in the presence of Life threatening complications: Signs of hyper viscosity → blast count > 100,000/uL, Hepatosplenomegaly causing respiratory compromise Heart failure (ejection fraction - 47% or shortening fraction - 27%) not directly the result of a congenital heart defect Hydrops fetalis Renal or hepatic dysfunction Disseminated intravascular coagulation with bleeding. COG trial: Adapted from Gamis et al, 2011