Treatment of Acute Lymphoblastic Leukemia (ALL)

Introduction to Treatment

The treatment of Acute Lymphoblastic Leukemia (ALL) requires intensive multiagent chemotherapy regimens administered in distinct phases (induction, consolidation, and maintenance) with specific modifications based on patient age, disease subtype, and risk stratification, as recommended by the National Comprehensive Cancer Network (NCCN) 1, 2

Poor prognostic factors for ALL include elevated WBC count, hypodiploidy, and MLL/KMT2A rearrangements, according to the National Comprehensive Cancer Network (NCCN) 3, 4
Elevated WBC count is defined as ≥30×10⁹/L for B-cell lineage and ≥100×10⁹/L for T-cell lineage, as stated by the NCCN 5

For adults <65 years with Ph-negative ALL, the National Comprehensive Cancer Network (NCCN) recommends multiagent regimens based on a backbone of vincristine, anthracyclines, corticosteroids, and L-asparaginase 1, 2, 5
For adults ≥65 years or with substantial comorbidities, the NCCN suggests low-intensity options such as vincristine and prednisone or POMP, and moderate-intensity options such as ALLOLD07, EWALL, GMALL, or GRAALL regimens 1
For pediatric patients, the NCCN recommends standard-risk 3-drug induction without anthracyclines and high-risk 4-drug induction including anthracyclines 5, 4

Consolidation therapy typically includes high-dose methotrexate, cytarabine, and other agents, and CNS prophylaxis with intrathecal chemotherapy is essential in all treatment regimens, as stated by the NCCN 2, 3, 5
Minimal residual disease (MRD) assessment guides further therapy, according to the NCCN 1

Dexamethasone shows better CNS penetration than prednisone but has higher toxicity risk, as noted by the NCCN 5

MRD monitoring is used to guide therapy intensification and consideration for stem cell transplantation, as recommended by the NCCN 1

The treatment of Acute Lymphoblastic Leukemia (ALL) requires intensive multiagent chemotherapy administered in distinct phases, with specific modifications based on patient age, disease subtype, and risk stratification, as recommended by the National Comprehensive Cancer Network 6

Risk assessment guides treatment intensity and consideration for allogeneic hematopoietic cell transplantation (HCT), according to the National Comprehensive Cancer Network 6

Standard maintenance regimens include daily mercaptopurine, weekly methotrexate, monthly vincristine, and pulse dexamethasone, as outlined by the National Comprehensive Cancer Network 6