This study aimed to compare the therapeutic efficacy of augmented post-induction treatment protocol for high risk childhood acute lymphoblastic leukemia versus standard intensive post induction protocol.Methods: the study was conducted at the KasrEl-Einy Centre for Oncology (NEMROCK)- faculty of Medicine , Cairo University. Previously untreated patients, aged between 2-15 years, classified as high risk for relapse were randomized into two groups after entering in Complete Remission; first group (22 patients) receiving standard intensive post induction therapy (I T), the second group received a new augmented post-induction treatment protocol (AIT) consistent of interchangeable blocks of different chemotheraputic agents throughout the maintenance period. Toxicity, cost of treatment protocol, preliminary relapse rate and event free survival for each protocol was assessed after a median survival of one and half year.Results: Therapy groups had similar baseline characteristics. Toxicity of treatment was comparable in both protocols except for significantly higher G III-IV mucositis in AIT(P= 0.001). The cost of AIT was significantly higher (P=0.001) although the cost of treatment of the patients who relapsed on AIT was not significantly more than IT protocol. Overall relapse rate in AIT was 9% versus 31% for IT group (P=0.055). Highest rate of relapse were found in slow responders to initial therapy in IT group (P=0.01), while in AIT age was the most significant risk factor (P=0.002). Mean Event free survival was 24 month in IT group versus 28 month in AIT group (P=0.087). There was significantly lower survival in patients having BCR-ABL rearrangement (P=0.04). Event free survival was significantly better in patients having BCR-ABL rearrangement and slow responders to initial therapy who were treated with AIT (P=0.02 and 0.03 respectively).Conclusion:Patients on AIT have better rate of relapse and Event free survival although not statistically significant, but it encourage us to proceed with this trial awaiting for longer follow up and bigger number of patients to be able to properly asses the efficacy of this new treatment protocol.