Materiały źródłowe

• #1 Typical Treatment of Acute Lymphocytic Leukemia (ALL) | American Cancer Society

  https://www.cancer.org/cancer/types/acute-lymphocytic-leukemia/treating/typical-treatment.html

  The main treatment for acute lymphocytic leukemia (ALL) in adults is typically long-term chemotherapy (chemo). Sometimes other types of drugs, such as targeted drugs or immunotherapy, might be part of the treatment as well. […] Treatment of ALL typically takes place in 3 phases: Induction (remission induction), Consolidation (intensification), Maintenance. […] The total treatment usually takes about 2 years, with the maintenance phase taking up most of this time. Treatment may be more or less intense, depending on the subtype of ALL and other prognostic factors. […] An important part of treatment for ALL is central nervous system (CNS) prophylaxis treatment that lowers the risk of the leukemia spreading to the area around the brain or spinal cord. […] The goal of induction chemo is to get the leukemia into remission (complete remission). This means that leukemia cells are no longer found in bone marrow samples, the normal marrow cells return, and the blood counts return to normal levels.

• #2 Treatment for acute lymphoblastic leukaemia (ALL)

  https://www.cancerresearchuk.org/about-cancer/acute-lymphoblastic-leukaemia-all/treatment

  Your treatment depends on several factors. These include what type of ALL you have, the cytogenetics of your leukaemia, and where it is in your body. It also depends on your general health and age. […] The main treatment for acute lymphoblastic leukaemia (ALL) is chemotherapy. But you may also have targeted cancer drugs, immunotherapy, or a stem cell transplant. […] Treatment for ALL usually starts quite quickly after diagnosis. You usually have steroids followed by chemotherapy. Find out about these and other treatments you might have such as a targeted cancer drug or stem cell transplant. […] Treatment for ALL is divided into different phases: induction, consolidation, intensification and maintenance. […] Chemotherapy is the main treatment for acute lymphoblastic leukaemia (ALL).

• #3 Treatment for acute lymphoblastic leukaemia – NHS

  https://www.nhs.uk/conditions/acute-lymphoblastic-leukaemia/treatment/

  Acute lymphoblastic leukaemia (ALL) is often treatable. […] Treatment usually needs to start quickly. […] It will usually include steroids and chemotherapy. It may also include targeted medicines, immunotherapy or a stem cell or bone marrow transplant. […] Steroid medicine aims to get rid of the leukaemia cells. […] Chemotherapy uses medicines to kill cancer cells. It’s the main treatment for acute lymphoblastic leukaemia. […] Targeted medicines aim to stop cancer growing. Immunotherapy is where medicines are used to help the immune system kill cancer. […] A stem cell or bone marrow transplant replaces damaged blood cells with healthy ones. […] You may need to have treatment to prevent or control symptoms caused by acute lymphoblastic leukaemia. […] Sometimes acute lymphoblastic leukaemia might be very hard to treat, and it may not be possible to cure the cancer. […] If this is the case, the aim of treatment will be to limit the cancer and its symptoms, and help you live longer.

• #4 Acute lymphocytic leukemia – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/acute-lymphocytic-leukemia/diagnosis-treatment/drc-20369083

  In general, treatment for acute lymphocytic leukemia falls into separate phases: […] The purpose of the first phase of treatment is to kill most of the leukemia cells in the blood and bone marrow and to restore normal blood cell production. […] Also called post-remission therapy, this phase of treatment is aimed at destroying any remaining leukemia in the body. […] The third phase of treatment prevents leukemia cells from regrowing. The treatments used in this stage are usually given at much lower doses over a long period of time, often years. […] During each phase of therapy, people with acute lymphocytic leukemia may receive additional treatment to kill leukemia cells located in the central nervous system. In this type of treatment, chemotherapy drugs are often injected directly into the fluid that covers the spinal cord.

• #5 Acute lymphoblastic leukemia treatment – Leukaemia Foundation

  https://www.leukaemia.org.au/blood-cancer/types-of-blood-cancer/leukaemia/acute-lymphoblastic-leukaemia/treatment/

  Because it progresses quickly, treatment needs to begin soon after ALL is diagnosed. The type of treatment used will depend on a number of factors including the sub-type of ALL, the genetic make-up of the leukaemic cells, your age and your general health. […] Chemotherapy is the main form of treatment for ALL. A combination of drugs, including steroids, is usually given in several cycles with a rest period of a few weeks in between. Initially, the aim of treatment is to destroy leukaemic cells and induce a remission. This means that there is no evidence of leukaemic cells in the blood and bone marrow and that normal blood cell production and blood counts are restored. In some cases, where there is a high risk that the leukaemia will relapse, patients may be offered even more intensive therapy followed by a stem cell transplant.

• #6 Typical Treatment of Acute Lymphocytic Leukemia (ALL) | American Cancer Society

  https://www.cancer.org/cancer/types/acute-lymphocytic-leukemia/treating/typical-treatment.html

  Induction chemo usually lasts for a month or so. […] Most often, leukemia goes into remission with induction chemotherapy. But because leukemia cells may still be hiding somewhere in the body, further treatment is needed. […] Treatment needs to be given either to keep the leukemia cells from spreading to the CNS (CNS prophylaxis), or to treat the leukemia if it has already spread to the CNS. […] If the leukemia goes into remission, the next phase often consists of another fairly short course of chemo, using many of the same drugs that were used for induction therapy. […] After consolidation, people generally get maintenance chemotherapy with methotrexate and 6-mercaptopurine (6-MP). […] Maintenance usually lasts for about 2 years. […] In general, about 80% to 90% of adults will have complete remissions at some point during these treatments.

• #7 Acute Lymphoblastic Leukemia (ALL): Symptoms, Treatment & Prognosis

  https://my.clevelandclinic.org/health/diseases/21564-acute-lymphocytic-leukemia

  Healthcare providers may treat ALL with long-term chemotherapy, targeted therapy, immunotherapy or stem cells (bone marrow) transplantation. Adults and children with ALL may receive different types of cancer drugs and treatments. […] Providers use chemotherapy as initial or front-line treatment for ALL. People with ALL receive chemotherapy in four phases. The treatment goal is to put ALL into complete remission. (Complete remission means treatment eliminates your symptoms, and tests show no sign of cancer.) […] Chemotherapy for ALL takes place over several months and sometimes years, and typically involves high doses of cancer-killing drugs. People receiving chemotherapy for ALL should consider palliative care to help manage treatment side effects. ALL chemotherapy includes: […] Remission induction therapy, which destroys as many leukemia cells as possible, so ALL goes into complete remission. Typically, people remain in the hospital during remission induction therapy. This treatment takes place over four to six weeks. Studies show more than 95% of children and 75% to 80% of adults with ALL will have complete remission after remission induction therapy.

• #8 Acute Lymphoblastic Leukemia (ALL) | Conditions | UCSF Health

  https://www.ucsfhealth.org/conditions/acute-lymphoblastic-leukemia

  The most common induction chemotherapy drugs used for ALL are daunorubicin, vincristine, prednisone, asparaginase and sometimes cyclophosphamide. During this phase, patients receive intensive supportive care, including transfusion of red blood cells and platelets. Antibiotics and anti-fungal medications are used to treat and prevent both bacterial and fungal infections. A medication known as G-CSF (Neupogen) can be used to help quickly reestablish a normal white blood count. […] […] Once blood counts have returned to normal, another bone marrow biopsy is performed to determine if the patient has entered complete remission. A complete remission is achieved when the blood and bone marrow show no evidence of persistent leukemia and blood counts have returned to normal. […] […] Chemotherapy drugs used during consolidation include the same ones used during induction, as well as Ara-C, etoposide, methotrexate and 6-mercaptopurine. The consolidation phase typically includes multiple cycles of intensive chemotherapy given over a six- to nine-month period. Frequent hospitalizations and intensive supportive care are still needed, including red blood cell and platelet transfusions. […]

• #9 Azthena logo with the word Azthena

  https://www.news-medical.net/health/Acute-Lymphoblastic-Leukemia-Treatment.aspx

  Consolidation this phase kills the remaining leukemia cells that have remained after an aggressive induction phase. […] Maintenance this is the final phase that involves regular chemotherapy pills to be taken orally to prevent a relapse of the leukemia. Maintenance phase is effective only in ALL and is not used in AML. […] The induction stage of treatment is provided in a hospital set up. Usually a combination of oral and intravenous chemotherapy drugs are administered. […] More than one chemotherapy agent is used in the induction phase. The most commonly used drugs include: Vincristine (Oncovin), Daunorubicin (daunomycin or Cerubidine) or doxorubicin (Adriamycin), Cytarabine (cytosine arabinoside, ara-C, or Cytosar), L-asparaginase or PEG-L-asparaginase, Etoposide (VP-16), Teniposide, 6-mercaptopurine (6-MP), Methotrexate, Cyclophosphamide, Prednisone, Dexamethasone etc.

• #10 Acute Lymphoblastic Leukemia (ALL) Treatment Protocols: Treatment Protocols

  https://emedicine.medscape.com/article/2004705-overview

  Treatment protocols for acute lymphoblastic leukemia (ALL) are provided below, including general treatment recommendations and commonly used treatment recommendations, as well as information on the following: […] The treatment regimen for patients with ALL is determined primarily by the Philadelphia chromosome status of the leukemia and the age of the patient. Patients with Philadelphia chromosome-positive (Ph+) ALL receive a tyrosine kinase inhibitor (TKI) in combination with chemotherapy. […] Treatment recommendations for patients who are diagnosed with ALL include induction, consolidation, and maintenance therapy along with CNS prophylaxis, as follows: […] Patients receive induction therapy with combinations of drugs, including vincristine, prednisone, cyclophosphamide, doxorubicin, and asparaginase, which are given over 4-6 weeks.

• #11 Acute Lymphoblastic Leukemia Treatment (PDQ®) – PDQ Cancer Information Summaries – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK65727/

  Sixty percent to 80% of adults with ALL usually achieve a complete remission after appropriate induction therapy. […] In patients with Ph-positive ALL, the remission rate is generally greater than 90% when standard induction regimens are combined with BCR::ABL1 tyrosine kinase inhibitors. […] Patients who experience a relapse after remission usually die within 1 year, even if a second complete remission is achieved. […] Blinatumomab is a bispecific antibody targeting CD19 and CD3. […] Inotuzumab ozogamicin is an antibody-drug conjugate targeting CD22, which contains a conjugated toxin, calicheamicin. […] Patients with Ph-positive ALL are often taking imatinib at the time of relapse and thus have imatinib-resistant disease. […] Revumenib is an oral menin inhibitor that is approved by the FDA for the treatment of relapsed or refractory acute leukemia with a KMT2A translocation in adult and pediatric patients aged 1 year and older.

• #12 How I treat newly diagnosed acute lymphoblastic leukemia

  https://pmc.ncbi.nlm.nih.gov/articles/PMC11088446/

  In recent years, immunotherapy appears increasingly important in addition to chemotherapy for adults with Ph- ALL. […] Blinatumomab, a bispecific anti-CD19/anti-CD3 T-cell enhancer, has been approved for treating patients in CR with MRD levels10-3 in the bone marrow. As shown by the results of the phase II study, it may allow for the eradication of MRD in 78% of patients in the first or subsequent CR. […] The use of modern PIR, incorporating all approved and available drugs, offers a chance of long-term survival to 50-70% of adults with Ph- ALL. […] For patients with Ph+ ALL the use of TKI is a priority. Imatinib in combination with reduced-intensity chemotherapy, followed by allo-HCT is currently recommended. […] Taken together, it seems that the use of second or third generation TKI in combination or in sequence with blinatumomab may markedly improve the prognosis of patients with Ph+ ALL, reducing the role of allo-HCT as part of the first-line treatment.

• #13 Acute Lymphoblastic Leukemia Treatment (PDQ®) – PDQ Cancer Information Summaries – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK65727/

  Sixty percent to 80% of adults with ALL usually achieve a complete remission after appropriate induction therapy. […] In patients with Ph-positive ALL, the remission rate is generally greater than 90% when standard induction regimens are combined with BCR::ABL1 tyrosine kinase inhibitors. […] Patients who experience a relapse after remission usually die within 1 year, even if a second complete remission is achieved. […] Blinatumomab is a bispecific antibody targeting CD19 and CD3. […] Inotuzumab ozogamicin is an antibody-drug conjugate targeting CD22, which contains a conjugated toxin, calicheamicin. […] Patients with Ph-positive ALL are often taking imatinib at the time of relapse and thus have imatinib-resistant disease. […] Revumenib is an oral menin inhibitor that is approved by the FDA for the treatment of relapsed or refractory acute leukemia with a KMT2A translocation in adult and pediatric patients aged 1 year and older.

• #14 Typical Treatment of Acute Lymphocytic Leukemia (ALL) | American Cancer Society

  https://www.cancer.org/cancer/types/acute-lymphocytic-leukemia/treating/typical-treatment.html

  Induction chemo usually lasts for a month or so. […] Most often, leukemia goes into remission with induction chemotherapy. But because leukemia cells may still be hiding somewhere in the body, further treatment is needed. […] Treatment needs to be given either to keep the leukemia cells from spreading to the CNS (CNS prophylaxis), or to treat the leukemia if it has already spread to the CNS. […] If the leukemia goes into remission, the next phase often consists of another fairly short course of chemo, using many of the same drugs that were used for induction therapy. […] After consolidation, people generally get maintenance chemotherapy with methotrexate and 6-mercaptopurine (6-MP). […] Maintenance usually lasts for about 2 years. […] In general, about 80% to 90% of adults will have complete remissions at some point during these treatments.

• #15 Acute Lymphoblastic Leukemia Treatment (PDQ®): Treatment – Health Professional Information [NCI] | Kaiser Permanente

  https://healthy.kaiserpermanente.org/health-wellness/health-encyclopedia/he.acute-lymphoblastic-leukemia-treatment-pdq%C2%AE-treatment-health-professional-information-nci.ncicdr0000062864

  Sixty percent to 80% of adults with ALL usually achieve a complete remission following appropriate induction therapy. Appropriate initial treatment, usually consisting of a regimen that includes the combination of vincristine, prednisone, and an anthracycline, with or without asparaginase, results in a complete response rate of up to 80%. In patients with Ph-positive ALL, the remission rate is generally greater than 90% when standard induction regimens are combined with BCR::ABL tyrosine kinase inhibitors. […] Patients with ALL who experience a relapse following chemotherapy and maintenance therapy are unlikely to be cured by further chemotherapy alone. These patients should be considered for reinduction chemotherapy followed by allogeneic BMT. […] Blinatumomab is a bispecific antibody targeting CD19 and CD3. The U.S. Food and Drug Administration (FDA) has approved blinatumomab for use in patients with relapsed or refractory B-cell ALL.

• #16 Acute lymphocytic leukemia – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/acute-lymphocytic-leukemia/diagnosis-treatment/drc-20369083

  Depending on your situation, the phases of treatment for acute lymphocytic leukemia can span two to three years. […] Treatments may include: […] Chemotherapy, which uses drugs to kill cancer cells, is typically used as an induction therapy for children and adults with acute lymphocytic leukemia. Chemotherapy drugs can also be used in the consolidation and maintenance phases. […] Targeted drug treatments focus on specific abnormalities present within cancer cells. By blocking these abnormalities, targeted drug treatments can cause cancer cells to die. Your leukemia cells will be tested to see if targeted therapy may be helpful for you. Targeted therapy can be used alone or in combination with chemotherapy for induction therapy, consolidation therapy or maintenance therapy. […] Radiation therapy uses high-powered beams, such as X-rays or protons, to kill cancer cells. If the cancer cells have spread to the central nervous system, your doctor may recommend radiation therapy.

• #17 Typical Treatment of Acute Lymphocytic Leukemia (ALL) | American Cancer Society

  https://www.cancer.org/cancer/types/acute-lymphocytic-leukemia/treating/typical-treatment.html

  Induction chemo usually lasts for a month or so. […] Most often, leukemia goes into remission with induction chemotherapy. But because leukemia cells may still be hiding somewhere in the body, further treatment is needed. […] Treatment needs to be given either to keep the leukemia cells from spreading to the CNS (CNS prophylaxis), or to treat the leukemia if it has already spread to the CNS. […] If the leukemia goes into remission, the next phase often consists of another fairly short course of chemo, using many of the same drugs that were used for induction therapy. […] After consolidation, people generally get maintenance chemotherapy with methotrexate and 6-mercaptopurine (6-MP). […] Maintenance usually lasts for about 2 years. […] In general, about 80% to 90% of adults will have complete remissions at some point during these treatments.

• #18 Acute Lymphoblastic Leukemia (ALL) | Conditions | UCSF Health

  https://www.ucsfhealth.org/conditions/acute-lymphoblastic-leukemia

  The most common induction chemotherapy drugs used for ALL are daunorubicin, vincristine, prednisone, asparaginase and sometimes cyclophosphamide. During this phase, patients receive intensive supportive care, including transfusion of red blood cells and platelets. Antibiotics and anti-fungal medications are used to treat and prevent both bacterial and fungal infections. A medication known as G-CSF (Neupogen) can be used to help quickly reestablish a normal white blood count. […] […] Once blood counts have returned to normal, another bone marrow biopsy is performed to determine if the patient has entered complete remission. A complete remission is achieved when the blood and bone marrow show no evidence of persistent leukemia and blood counts have returned to normal. […] […] Chemotherapy drugs used during consolidation include the same ones used during induction, as well as Ara-C, etoposide, methotrexate and 6-mercaptopurine. The consolidation phase typically includes multiple cycles of intensive chemotherapy given over a six- to nine-month period. Frequent hospitalizations and intensive supportive care are still needed, including red blood cell and platelet transfusions. […]

• #19 Acute Lymphoblastic Leukemia (ALL) | Conditions | UCSF Health

  https://www.ucsfhealth.org/conditions/acute-lymphoblastic-leukemia

  The most common induction chemotherapy drugs used for ALL are daunorubicin, vincristine, prednisone, asparaginase and sometimes cyclophosphamide. During this phase, patients receive intensive supportive care, including transfusion of red blood cells and platelets. Antibiotics and anti-fungal medications are used to treat and prevent both bacterial and fungal infections. A medication known as G-CSF (Neupogen) can be used to help quickly reestablish a normal white blood count. […] […] Once blood counts have returned to normal, another bone marrow biopsy is performed to determine if the patient has entered complete remission. A complete remission is achieved when the blood and bone marrow show no evidence of persistent leukemia and blood counts have returned to normal. […] […] Chemotherapy drugs used during consolidation include the same ones used during induction, as well as Ara-C, etoposide, methotrexate and 6-mercaptopurine. The consolidation phase typically includes multiple cycles of intensive chemotherapy given over a six- to nine-month period. Frequent hospitalizations and intensive supportive care are still needed, including red blood cell and platelet transfusions. […]

• #20 Acute Lymphoblastic Leukemia (ALL) Treatment Protocols: Treatment Protocols

  https://emedicine.medscape.com/article/2004705-overview

  Patients then receive consolidation (intensification) with multiagent therapy, including cytarabine and methotrexate; there is no role for radiation or surgical treatment in the induction phase. […] Maintenance therapy includes 6-mercaptopurine, methotrexate, steroids, and vincristine; intrathecal methotrexate is administered throughout. […] Newer studies with intensive multiagent chemotherapy (eg, the CALGB [Cancer and Leukemia Group B]- 8811 and hyper-CVAD [hyperfractionated cyclophosphamide, vincristine, doxorubicin, and dexamethasone] regimens and the ALL-2 regimen) plus the addition of TKIs for Ph+ ALL and rituximab for CD20-positive ALL have resulted in 3-year survivals of 50% or more in adults. […] Ph+ ALL in the older adult (age 40 y): Chemotherapy (eg, hyper-CVAD) plus TKI; consider allogeneic stem cell transplantation if an appropriate donor is available and the patient has a good performance status and no or limited comorbidities; if transplantation is not feasible, continue multiagent chemotherapy and a TKI.

• #21 Treatment for acute lymphoblastic leukaemia (ALL leukemia) | Macmillan Cancer Support

  https://www.macmillan.org.uk/cancer-information-and-support/leukaemia/acute-lymphoblastic-leukaemia-all-treatment

  A donor stem cell transplant is an intensive treatment that may increase the chances of curing ALL or keep it in remission for longer. This treatment is not suitable or needed for everyone. […] Treatment for ALL is usually given in 3 main phases. […] Induction phase chemotherapy and other drugs are given to get rid of the leukaemia cells in your blood and bone marrow. […] Consolidation (or intensification) treatment to get rid of any remaining leukaemia cells in areas such as the brain or spinal cord. […] Maintenance phase to reduce the risk of leukaemia coming back. This is also called maintenance therapy. […] During treatment, your doctors and nurses will take blood, bone marrow and lumbar puncture samples to check for leukaemia cells. The results of these tests help doctors: find out how well your treatment is working, see whether the leukaemia is more likely to come back, decide what treatment you may need next to give you the best chance of a cure.

• #22 How I treat newly diagnosed acute lymphoblastic leukemia

  https://pmc.ncbi.nlm.nih.gov/articles/PMC11088446/

  The consolidation phase includes alternating courses of chemotherapy, consisting of high doses (HD) of MTX, HD-AraC, CP, etoposide, asparaginase, and dexamethasone. The treatment algorithm may include a re-induction phase, i.e., a repeated course of the drugs used during initial induction. Repeated administration of high doses of polyethylene glycol (PEG)-asparaginase (2000 IU/m2) is a feature of PIR. […] Allo-HCT effectively prevents relapse in ALL adults, combining the conditioning regimens anti-leukemic activity and beneficial graft-versus-leukemia reaction mediated by donor-derived immune cells. Unfortunately, it is associated with a significant risk of non-relapse mortality (NRM) affecting 15-22% of patients, depending on the donor type. Therefore, Ph- ALL allo-HCT in the first CR is considered only for patients with a high estimated risk of relapse.

• #23 Treatment for acute lymphoblastic leukaemia (ALL)

  https://www.cancerresearchuk.org/about-cancer/acute-lymphoblastic-leukaemia-all/treatment

  You may have immunotherapy or a targeted cancer drug to help treat some types of ALL. Targeted cancer drugs work by targeting the differences in cancer cells that help them to grow and survive. Immunotherapy, such as CAR T-cell therapy uses the immune system to attack the cancer. […] You might have a stem cell transplant as part of your treatment for ALL. In ALL, you have the stem cells from someone else (a donor). This is called an allogeneic transplant. […] Leukaemia that does not go away with treatment is called refractory leukaemia. If it comes back after treatment it is called relapsed disease. […] Treatment for acute lymphoblastic leukaemia (ALL) might cause short and long term side effects. Short term side effects happen during treatment or very soon after you finish. Long term side effects can develop weeks, months or years after treatment has ended. […] You have follow up appointments and tests after treatment for ALL to check how you are and monitor any side effects or symptoms.

• #24 Typical Treatment of Acute Lymphocytic Leukemia (ALL) | American Cancer Society

  https://www.cancer.org/cancer/types/acute-lymphocytic-leukemia/treating/typical-treatment.html

  Induction chemo usually lasts for a month or so. […] Most often, leukemia goes into remission with induction chemotherapy. But because leukemia cells may still be hiding somewhere in the body, further treatment is needed. […] Treatment needs to be given either to keep the leukemia cells from spreading to the CNS (CNS prophylaxis), or to treat the leukemia if it has already spread to the CNS. […] If the leukemia goes into remission, the next phase often consists of another fairly short course of chemo, using many of the same drugs that were used for induction therapy. […] After consolidation, people generally get maintenance chemotherapy with methotrexate and 6-mercaptopurine (6-MP). […] Maintenance usually lasts for about 2 years. […] In general, about 80% to 90% of adults will have complete remissions at some point during these treatments.

• #25 Acute lymphoblastic leukemia treatment – Leukaemia Foundation

  https://www.leukaemia.org.au/blood-cancer/types-of-blood-cancer/leukaemia/acute-lymphoblastic-leukaemia/treatment/

  Treatment for ALL can be divided into three phases: induction therapy, post-remission (consolidation) therapy, maintenance therapy. […] Soon after you are diagnosed your doctor will need to begin an intensive course of treatment to bring about, or induce, a remission. You will need to be admitted to hospital for this first phase of treatment. […] Soon after induction therapy finishes and remission is achieved, more treatment is required to help destroy any leftover disease in your body. This is important because it helps to prevent the disease from reappearing (relapsing), or spreading to the central nervous system (brain and spinal cord) in the future. […] Maintenance therapy is designed to help keep your disease in remission and prevent it from reappearing (relapsing) in the future. Common maintenance protocols involve chemotherapy tablets — some taken daily and others weekly — and possibly blocks of injections of chemotherapy with courses of cortico-steroids.

• #26 Acute Lymphoblastic Leukemia (ALL) | Conditions | UCSF Health

  https://www.ucsfhealth.org/conditions/acute-lymphoblastic-leukemia

  Once patients have completed intensive chemotherapy, they need to take oral chemotherapy pills for an additional 18 to 24 months. These pills typically methotrexate and 6-mercaptopurine are usually well-tolerated with only minimal side effects. Patients need to have blood tests once a month while taking chemotherapy pills. Most patients with ALL can return to work during maintenance therapy. […] […] ALL often recurs in the cerebrospinal fluid the fluid that bathes the spinal column and brain. To prevent this, chemotherapy is injected directly into the cerebrospinal fluid. This is done by inserting a needle between the vertebrae of the lower back called a spinal tap or lumbar puncture and infusing chemotherapy directly into the clear cerebrospinal fluid. This procedure is called intrathecal chemotherapy. […]

• #27 Acute Lymphoblastic Leukemia (ALL) – Hematology and Oncology – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/hematology-and-oncology/leukemias/acute-lymphoblastic-leukemia-all

  For patients with Philadelphia chromosomepositive (Ph+) ALL, a tyrosine kinase inhibitor (eg, imatinib, dasatinib) can be added to the drug regimen. […] The goal of consolidation is to prevent leukemic regrowth. […] Most regimens include maintenance therapy with monthly vincristine, weekly methotrexate, daily mercaptopurine, and 5 days/month corticosteroid. […] CNS prophylaxis starts during induction and continues throughout all phases of treatment. […] Supportive care is similar in the acute leukemias and may include transfusions, antimicrobials, hydration and urine alkalinization, and psychologic support. […] Stem cell transplantation following reinduction chemotherapy or immunotherapy offers the greatest hope of long-term remission or cure if an HLA-matched sibling is available.

• #28 Acute Lymphoblastic Leukemia (ALL) | Conditions | UCSF Health

  https://www.ucsfhealth.org/conditions/acute-lymphoblastic-leukemia

  Once patients have completed intensive chemotherapy, they need to take oral chemotherapy pills for an additional 18 to 24 months. These pills typically methotrexate and 6-mercaptopurine are usually well-tolerated with only minimal side effects. Patients need to have blood tests once a month while taking chemotherapy pills. Most patients with ALL can return to work during maintenance therapy. […] […] ALL often recurs in the cerebrospinal fluid the fluid that bathes the spinal column and brain. To prevent this, chemotherapy is injected directly into the cerebrospinal fluid. This is done by inserting a needle between the vertebrae of the lower back called a spinal tap or lumbar puncture and infusing chemotherapy directly into the clear cerebrospinal fluid. This procedure is called intrathecal chemotherapy. […]

• #29 Acute Lymphoblastic Leukemia (ALL) | Conditions | UCSF Health

  https://www.ucsfhealth.org/conditions/acute-lymphoblastic-leukemia

  Once patients have completed intensive chemotherapy, they need to take oral chemotherapy pills for an additional 18 to 24 months. These pills typically methotrexate and 6-mercaptopurine are usually well-tolerated with only minimal side effects. Patients need to have blood tests once a month while taking chemotherapy pills. Most patients with ALL can return to work during maintenance therapy. […] […] ALL often recurs in the cerebrospinal fluid the fluid that bathes the spinal column and brain. To prevent this, chemotherapy is injected directly into the cerebrospinal fluid. This is done by inserting a needle between the vertebrae of the lower back called a spinal tap or lumbar puncture and infusing chemotherapy directly into the clear cerebrospinal fluid. This procedure is called intrathecal chemotherapy. […]

• #30 Treatment for acute lymphoblastic leukaemia (ALL)

  https://www.cancerresearchuk.org/about-cancer/acute-lymphoblastic-leukaemia-all/treatment

  Your treatment depends on several factors. These include what type of ALL you have, the cytogenetics of your leukaemia, and where it is in your body. It also depends on your general health and age. […] The main treatment for acute lymphoblastic leukaemia (ALL) is chemotherapy. But you may also have targeted cancer drugs, immunotherapy, or a stem cell transplant. […] Treatment for ALL usually starts quite quickly after diagnosis. You usually have steroids followed by chemotherapy. Find out about these and other treatments you might have such as a targeted cancer drug or stem cell transplant. […] Treatment for ALL is divided into different phases: induction, consolidation, intensification and maintenance. […] Chemotherapy is the main treatment for acute lymphoblastic leukaemia (ALL).

• #31 Treatment for acute lymphoblastic leukaemia – NHS

  https://www.nhs.uk/conditions/acute-lymphoblastic-leukaemia/treatment/

  Acute lymphoblastic leukaemia (ALL) is often treatable. […] Treatment usually needs to start quickly. […] It will usually include steroids and chemotherapy. It may also include targeted medicines, immunotherapy or a stem cell or bone marrow transplant. […] Steroid medicine aims to get rid of the leukaemia cells. […] Chemotherapy uses medicines to kill cancer cells. It’s the main treatment for acute lymphoblastic leukaemia. […] Targeted medicines aim to stop cancer growing. Immunotherapy is where medicines are used to help the immune system kill cancer. […] A stem cell or bone marrow transplant replaces damaged blood cells with healthy ones. […] You may need to have treatment to prevent or control symptoms caused by acute lymphoblastic leukaemia. […] Sometimes acute lymphoblastic leukaemia might be very hard to treat, and it may not be possible to cure the cancer. […] If this is the case, the aim of treatment will be to limit the cancer and its symptoms, and help you live longer.

• #32 Childhood Acute Lymphoblastic Leukemia – NCI

  https://www.cancer.gov/types/leukemia/patient/child-all-treatment-pdq

  Types of treatment for childhood acute lymphoblastic leukemia […] Treatment options depend on: […] Types of treatment your child might have include: […] Chemotherapy (also called chemo) uses drugs to stop the growth of cancer cells. Chemotherapy either kills the cells or stops them from dividing. Chemotherapy may be given alone or with other types of treatment. […] Radiation therapy uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing. Childhood ALL is treated with external beam radiation therapy. […] Stem cell transplant is a treatment to replace the blood-forming cells. […] Immunotherapy is a treatment that uses the patient’s immune system to fight cancer. […] Targeted therapy uses drugs or other substances to block the action of specific enzymes, proteins, or other molecules involved in the growth and spread of cancer cells.

• #33 Treatment for acute lymphoblastic leukaemia (ALL leukemia) | Macmillan Cancer Support

  https://www.macmillan.org.uk/cancer-information-and-support/leukaemia/acute-lymphoblastic-leukaemia-all-treatment

  There are different treatments for acute lymphoblastic leukaemia. Treatment usually starts as soon as possible after diagnosis. […] The aim of treatment for acute lymphoblastic leukaemia (also called ALL or ALL leukemia) is to get rid of the leukaemia cells as quickly as possible, so your bone marrow can work normally again. This is called remission. […] Treatment options include: […] Chemotherapy uses anti-cancer (cytotoxic) drugs to destroy the cancer cells. This is the main treatment for ALL. You will have several different chemotherapy drugs. Most of the drugs will be given into a vein (intravenously). You will take others by mouth as tablets. […] At times during treatment you will have chemotherapy given into the fluid around your spine and brain (cerebrospinal fluid). This is called intrathecal chemotherapy. It may be given to treat or prevent leukaemia in this area of the body.

• #34 Acute lymphoblastic leukemia – Wikipedia

  https://en.wikipedia.org/wiki/Acute_lymphoblastic_leukemia

  Acute lymphoblastic leukemia is typically treated initially with chemotherapy aimed at bringing about remission. […] This is then followed by further chemotherapy typically over a number of years. […] Treatment usually also includes intrathecal chemotherapy since systemic chemotherapy can have limited penetration into the central nervous system and the central nervous system is a common site for relapse of acute lymphoblastic leukemia. […] Treatment can also include radiation therapy if spread to the brain has occurred. […] Stem cell transplantation may be used if the disease recurs following standard treatment. […] Additional treatments such as Chimeric antigen receptor T cell immunotherapy are being used and further studied. […] Over the past several decades, there have been strides to increase the efficacy of treatment regimens, resulting in increased survival rates. Possible treatments for acute leukemia include chemotherapy, steroids, radiation therapy, intensive combined treatments (including bone marrow or stem cell transplants), targeted therapy, and/or growth factors.

• #35 Acute lymphoblastic leukemia – Wikipedia

  https://en.wikipedia.org/wiki/Acute_lymphoblastic_leukemia

  Chemotherapy is the initial treatment of choice, and most people with ALL receive a combination of medications. […] In general, cytotoxic chemotherapy for ALL combines multiple antileukemic drugs tailored to each person. […] Adult chemotherapy regimens mimic those of childhood ALL; however, are linked with a higher risk of disease relapse with chemotherapy alone. […] Recent updates on the treatment of adult acute lymphoblastic leukemia (ALL) include advancements in immunotherapy, particularly the use of monoclonal antibodies like blinatumomab and inotuzumab ozogamicin, which target specific cancer cells and are used alongside stem cell transplantation.

• #36 Evolving therapy of adult acute lymphoblastic leukemia: state-of-the-art treatment and future directions | Journal of Hematology & Oncology | Full Text

  https://jhoonline.biomedcentral.com/articles/10.1186/s13045-020-00905-2

  However, recent years have witnessed the introduction of novel agents, which showed significant survival benefit against standard therapies and expanded the armamentarium of ALL. […] The efficacy of these novel antibody constructs in ALL provides a rationale to combine either or both agents with lower intensity chemotherapy backbone with the goal of further improving outcomes. […] The combination of venetoclax with lower-intensity chemotherapy is being evaluated in several prospective trials, including for untreated older patients or patients with R/R ALL. […] CAR T cell therapy targeting CD19 is novel immunotherapy that has shown high clinical efficacy in R/R B cell ALL. […] The addition of TKIs to chemotherapy has revolutionized therapy of patients with Ph-positive ALL, and is now standard of care.

• #37 Acute Lymphoblastic Leukemia (ALL) Treatment | St. Jude Care & Treatment

  https://www.stjude.org/care-treatment/treatment/childhood-cancer/leukemia-lymphoma/acute-lymphoblastic-leukemia-all.html

  Chemotherapy is the main treatment for ALL. It has 3 phases and can take 22.5 years to complete. […] The treatment plan depends on the chance that the leukemia may not respond to treatment or may come back after treatment has finished. This is called risk-based treatment. […] St. Jude groups ALL cases as low risk, standard risk, and high risk. Cases that are most likely to respond to treatment are low risk. Leukemia that is the hardest to treat is high risk. […] Children with low-risk ALL get less medicine than children with standard-risk ALL. Children with high-risk ALL get more medicine than children with standard-risk ALL. They may need more treatments such as immunotherapy or stem cell (bone marrow) transplant. […] For specific types of ALL, children may get targeted therapy or immunotherapy. These therapies help the body identify and kill certain types of cancer cells.

• #38 Typical Treatment of Acute Lymphocytic Leukemia (ALL) | American Cancer Society

  https://www.cancer.org/cancer/types/acute-lymphocytic-leukemia/treating/typical-treatment.html

  Induction chemo usually lasts for a month or so. […] Most often, leukemia goes into remission with induction chemotherapy. But because leukemia cells may still be hiding somewhere in the body, further treatment is needed. […] Treatment needs to be given either to keep the leukemia cells from spreading to the CNS (CNS prophylaxis), or to treat the leukemia if it has already spread to the CNS. […] If the leukemia goes into remission, the next phase often consists of another fairly short course of chemo, using many of the same drugs that were used for induction therapy. […] After consolidation, people generally get maintenance chemotherapy with methotrexate and 6-mercaptopurine (6-MP). […] Maintenance usually lasts for about 2 years. […] In general, about 80% to 90% of adults will have complete remissions at some point during these treatments.

• #39 Treatment for Acute Lymphocytic Leukemia (ALL) | Memorial Sloan Kettering Cancer Center

  https://www.mskcc.org/cancer-care/types/leukemias/treatment/acute-lymphocytic-leukemia

  During the maintenance phase, you may receive lower doses of drugs but for long periods of time, typically two years. This will destroy any remaining leukemia cells. […] CAR T cell therapy is an exciting and powerful new treatment for certain people up to age 25 whose ALL has stopped responding to other therapies. […] If you have been diagnosed with Philadelphia-positive ALL (Ph-Positive ALL), you may receive certain targeted therapies that have proven particularly effective against this subtype of the disease. […] Our doctors are experienced in preventing or controlling central nervous system involvement. We may administer chemotherapy directly to the fluid around the spinal cord and brain. This procedure is called intrathecal chemotherapy. […] Our researchers are constantly pursuing new ways to treat ALL. These approaches can kill tumor cells directly, slow down the body’s production of substances that promote their growth, or enhance the immune response against the leukemia cells. […] Some of the newer combination chemotherapy approaches that were evaluating in adults are inspired by innovative treatments developed for children with ALL. These treatments may be more effective than existing standard therapies.

• #40

• #41 Acute Lymphoblastic Leukemia (ALL) – Hematology and Oncology – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/hematology-and-oncology/leukemias/acute-lymphoblastic-leukemia-all

  Treatment typically includes combination chemotherapy to achieve remission, intrathecal and systemic chemotherapy and/or corticosteroids for CNS prophylaxis, and sometimes cerebral irradiation for intracerebral leukemic infiltration, consolidation chemotherapy with or without stem cell transplantation, and maintenance chemotherapy for up to 3 years to avoid relapse. […] Treatment for newly diagnosed acute lymphoblastic leukemia generally consists of 3 to 4 cycles of chemotherapy blocks of noncross-resistant chemotherapy for the first 9 to 12 months, followed by 2.5 to 3 years of maintenance chemotherapy. […] The goal of induction treatment is complete remission, defined as 1000/mcL (1 109/L), a platelet count 100,000/mcL (100 109/L), and no need for blood transfusion. […] Components of induction therapy include a high-dose corticosteroid (eg, dexamethasone, prednisone), an anthracycline (eg, daunorubicin, doxorubicin, idarubicin), and vincristine.

• #42 Acute Lymphoblastic Leukemia (ALL) – Hematology and Oncology – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/hematology-and-oncology/leukemias/acute-lymphoblastic-leukemia-all

  For patients with Philadelphia chromosomepositive (Ph+) ALL, a tyrosine kinase inhibitor (eg, imatinib, dasatinib) can be added to the drug regimen. […] The goal of consolidation is to prevent leukemic regrowth. […] Most regimens include maintenance therapy with monthly vincristine, weekly methotrexate, daily mercaptopurine, and 5 days/month corticosteroid. […] CNS prophylaxis starts during induction and continues throughout all phases of treatment. […] Supportive care is similar in the acute leukemias and may include transfusions, antimicrobials, hydration and urine alkalinization, and psychologic support. […] Stem cell transplantation following reinduction chemotherapy or immunotherapy offers the greatest hope of long-term remission or cure if an HLA-matched sibling is available.

• #43 Acute lymphocytic leukemia – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/acute-lymphocytic-leukemia/diagnosis-treatment/drc-20369083

  Depending on your situation, the phases of treatment for acute lymphocytic leukemia can span two to three years. […] Treatments may include: […] Chemotherapy, which uses drugs to kill cancer cells, is typically used as an induction therapy for children and adults with acute lymphocytic leukemia. Chemotherapy drugs can also be used in the consolidation and maintenance phases. […] Targeted drug treatments focus on specific abnormalities present within cancer cells. By blocking these abnormalities, targeted drug treatments can cause cancer cells to die. Your leukemia cells will be tested to see if targeted therapy may be helpful for you. Targeted therapy can be used alone or in combination with chemotherapy for induction therapy, consolidation therapy or maintenance therapy. […] Radiation therapy uses high-powered beams, such as X-rays or protons, to kill cancer cells. If the cancer cells have spread to the central nervous system, your doctor may recommend radiation therapy.

• #44 Acute lymphoblastic leukemia (ALL): Symptoms, causes, and treatment

  https://www.medicalnewstoday.com/articles/215500

  Targeted therapy is a relatively new strategy that involves targeting specific proteins, genes, or other factors that encourage cancer to grow. Blocking these factors can delay or prevent the growth of cancer. As the treatment has a specific target, it should produce fewer side effects than chemotherapy, but adverse effects are still possible. […] Immunotherapy is another new treatment option. It aims to help the body defeat cancer by boosting the action of the immune system. […] The primary form of treatment for children with leukemia is chemotherapy. […] The initial treatment is intense, and the child will usually need to spend time in the hospital. However, more than 95% of children with ALL enter remission after 1 month of initial treatment. […] The Dana-Farber Cancer Institute notes that 15-20% of children achieve remission but experience a relapse later. However, it also states that the cure rate is more than 90%.

• #45 How I treat newly diagnosed acute lymphoblastic leukemia

  https://pmc.ncbi.nlm.nih.gov/articles/PMC11088446/

  In recent years, immunotherapy appears increasingly important in addition to chemotherapy for adults with Ph- ALL. […] Blinatumomab, a bispecific anti-CD19/anti-CD3 T-cell enhancer, has been approved for treating patients in CR with MRD levels10-3 in the bone marrow. As shown by the results of the phase II study, it may allow for the eradication of MRD in 78% of patients in the first or subsequent CR. […] The use of modern PIR, incorporating all approved and available drugs, offers a chance of long-term survival to 50-70% of adults with Ph- ALL. […] For patients with Ph+ ALL the use of TKI is a priority. Imatinib in combination with reduced-intensity chemotherapy, followed by allo-HCT is currently recommended. […] Taken together, it seems that the use of second or third generation TKI in combination or in sequence with blinatumomab may markedly improve the prognosis of patients with Ph+ ALL, reducing the role of allo-HCT as part of the first-line treatment.

• #46 Acute Lymphoblastic Leukemia (ALL): Symptoms, Diagnosis, Treatment, Prognosis, and Survival Rate

  https://www.webmd.com/cancer/lymphoma/acute-lymphoblastic-leukemia

  Targeted therapy. Some drugs target specific parts of cancer cells and tend to have fewer or milder side effects than chemotherapy. They include bosutinib (Bosulif), dasatinib (Sprycel), imatinib (Gleevec), nilotinib (Tasigna), and ponatinib (Iclusig). […] Radiation therapy. Your doctor might use high-energy radiation to kill cancer cells if theyve reached your brain or bone or before you have a stem cell transplant. […] Immunotherapy. These drugs boost your immune system to kill or slow the growth of cancer cells. They include blinatumomab (Blincyto) and inotuzumab ozogamicin (Besponsa). The FDA has also approved a form of treatment called CAR T-cell therapy. It uses some of your own immune cells, called T cells, to treat your cancer. Doctors take the cells out of your blood and add genes to them. The new T cells are better able to find and kill cancer cells.

• #47 Active treatment for acute lymphoblastic leukaemia (ALL) | Blood Cancer UK

  https://bloodcancer.org.uk/understanding-blood-cancer/leukaemia/acute-lymphoblastic-leukaemia/all-treatments-side-effects/all-active-treatment/

  When used alongside standard chemotherapy, TKIs can significantly increase the chance of a cure for people with Philadelphia positive ALL. […] Around this time, you may also have what’s called intrathecal chemotherapy to give extra protection to your brain and spinal cord. […] This phase is sometimes called post-induction or post-remission therapy. […] Its usual for some leukaemia cells to remain after your initial chemotherapy, even if doctors can’t see any under the microscope. So when the remission induction phase is finished, you’ll have more chemotherapy to clear any leukaemia cells that might remain in your blood and bone marrow. […] Some people may be offered a stem cell transplant (also called a bone marrow transplant) during the consolidation phase. […] A transplant aims to give you healthy stem cells, which then produce normal blood cells.

• #48 Treatment for acute lymphoblastic leukaemia (ALL)

  https://www.cancerresearchuk.org/about-cancer/acute-lymphoblastic-leukaemia-all/treatment

  You may have immunotherapy or a targeted cancer drug to help treat some types of ALL. Targeted cancer drugs work by targeting the differences in cancer cells that help them to grow and survive. Immunotherapy, such as CAR T-cell therapy uses the immune system to attack the cancer. […] You might have a stem cell transplant as part of your treatment for ALL. In ALL, you have the stem cells from someone else (a donor). This is called an allogeneic transplant. […] Leukaemia that does not go away with treatment is called refractory leukaemia. If it comes back after treatment it is called relapsed disease. […] Treatment for acute lymphoblastic leukaemia (ALL) might cause short and long term side effects. Short term side effects happen during treatment or very soon after you finish. Long term side effects can develop weeks, months or years after treatment has ended. […] You have follow up appointments and tests after treatment for ALL to check how you are and monitor any side effects or symptoms.

• #49 Evolving therapy of adult acute lymphoblastic leukemia: state-of-the-art treatment and future directions | Journal of Hematology & Oncology | Full Text

  https://jhoonline.biomedcentral.com/articles/10.1186/s13045-020-00905-2

  Recent years have witnessed major advances that have improved outcome of adults with acute lymphoblastic leukemia (ALL). The treatment paradigms of ALL have been revolutionized with the advent of tyrosine kinase inhibitors targeting BCR-ABL1, monoclonal antibodies targeting CD20 (rituximab), antibody-drug conjugates targeting CD22 (inotuzumab ozogamicin), bispecific antibodies (blinatumomab), and CD19 chimeric antigen receptor T cell therapy (tisagenlecleucel). […] These highly effective new agents are allowing for novel approaches that reduce reliance on intensive cytotoxic chemotherapy and hematopoietic stem cell transplantation in first remission. […] The prognosis of R/R ALL has historically been dismal with complete remission (CR) rates of 20-40%, median overall survival (OS) of 6 months, and cure rates of 10% even with intensive salvage chemotherapy and HSCT.

• #50 Treatment for acute lymphoblastic leukaemia (ALL leukemia) | Macmillan Cancer Support

  https://www.macmillan.org.uk/cancer-information-and-support/leukaemia/acute-lymphoblastic-leukaemia-all-treatment

  You almost always have steroids during treatment for ALL. You usually start having steroids a few days before you start chemotherapy. Steroids can: destroy leukaemia cells, make chemotherapy more effective, reduce allergic reactions caused by some chemotherapy drugs, prevent side effects such as feeling sick (nausea). […] If tests show you have a type of ALL called Philadelphia positive ALL (Ph+ ALL), your treatment will include a type of targeted therapy drug called a tyrosine kinase inhibitor (TKI). Imatinib is the most commonly used TKI drug for ALL. […] Immunotherapy drugs use the body’s own immune system to recognise and destroy leukaemia cells. A drug called rituximab is sometimes used to treat B-cell ALL if tests show the leukaemia cells have a protein called CD20 on their surface.

• #51 Acute Lymphoblastic Leukemia Treatment (PDQ®) – PDQ Cancer Information Summaries – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK65727/

  Sixty percent to 80% of adults with ALL usually achieve a complete remission after appropriate induction therapy. […] In patients with Ph-positive ALL, the remission rate is generally greater than 90% when standard induction regimens are combined with BCR::ABL1 tyrosine kinase inhibitors. […] Patients who experience a relapse after remission usually die within 1 year, even if a second complete remission is achieved. […] Blinatumomab is a bispecific antibody targeting CD19 and CD3. […] Inotuzumab ozogamicin is an antibody-drug conjugate targeting CD22, which contains a conjugated toxin, calicheamicin. […] Patients with Ph-positive ALL are often taking imatinib at the time of relapse and thus have imatinib-resistant disease. […] Revumenib is an oral menin inhibitor that is approved by the FDA for the treatment of relapsed or refractory acute leukemia with a KMT2A translocation in adult and pediatric patients aged 1 year and older.

• #52 How I treat newly diagnosed acute lymphoblastic leukemia

  https://pmc.ncbi.nlm.nih.gov/articles/PMC11088446/

  In recent years, immunotherapy appears increasingly important in addition to chemotherapy for adults with Ph- ALL. […] Blinatumomab, a bispecific anti-CD19/anti-CD3 T-cell enhancer, has been approved for treating patients in CR with MRD levels10-3 in the bone marrow. As shown by the results of the phase II study, it may allow for the eradication of MRD in 78% of patients in the first or subsequent CR. […] The use of modern PIR, incorporating all approved and available drugs, offers a chance of long-term survival to 50-70% of adults with Ph- ALL. […] For patients with Ph+ ALL the use of TKI is a priority. Imatinib in combination with reduced-intensity chemotherapy, followed by allo-HCT is currently recommended. […] Taken together, it seems that the use of second or third generation TKI in combination or in sequence with blinatumomab may markedly improve the prognosis of patients with Ph+ ALL, reducing the role of allo-HCT as part of the first-line treatment.

• #53 Acute Lymphoblastic Leukemia Immunotherapy Treatment: Now, Next, and Beyond

  https://www.mdpi.com/2072-6694/15/13/3346

  BsAbs are antibodies engineered to contain two different fragment-binding antigens (Fabs) regions that allow for the concurrent targeting of two antigens. One of the main mechanisms of action of BsAbs is to recruit and activate effector cells (i.e., T cells) against target cells (i.e., tumor cells). These antibodies, unlike conventional ones, induce enhanced T-cell activation. […] Blinatumomab is a bispecific T-cell-engaging (BiTE) antibody. BiTE antibodies lack the Fc fragment and are composed of the fusion of two different single-chain variable fragments (scFvs); one scFv binds the CD3 expressed on effector T cells and the other binds a tumor-associated antigen. Blinatumomab, by simultaneously binding CD19 on B-ALL cells and CD3 on T cells, can mediate a direct cross-link between T cells and tumor cells, resulting in targeted and highly effective tumor cell killing.

• #54 What You Should Know About Acute Lymphoblastic Leukemia ‌|‌ ‌University‌ ‌of‌ ‌Kansas‌ ‌Cancer‌ ‌Center‌

  https://www.kucancercenter.org/news-room/blog/2020/10/what-you-should-know-acute-lymphoblastic-leukemia

  Acute lymphoblastic leukemia treatment has many options for cancer treatments. The treatment of ALL is tailored to the individual based on their age, disease progression and subtype. […] The main treatment for ALL in adults is usually chemotherapy courses that have improved outcomes in this population. Chemotherapy is a cell-killing drug. Unfortunately, these intense regimens are more likely to cause problematic side effects, like low WBCs. Chemotherapy is often used in conjunction with steroids like prednisone. […] Stem cell transplant may also be a treatment option. This entails infusing healthy stem cells provided by a donor into the patients bloodstream. The new healthy cells can help rebuild a healthy immune system in the patient. […] CAR T-cell therapy is also a treatment option. This innovative approach involves extracting the patients T cells, reengineering them in a lab to recognize and fight cancer cells, expanding those supercharged cells, and returning them to the patients body.

• #55 Use of CAR T-cell for acute lymphoblastic leukemia (ALL) treatment: a review study | Cancer Gene Therapy

  https://www.nature.com/articles/s41417-021-00418-1

  There are currently five FDA-approved CAR T-cell therapies, including Lisocabtagene Maraleucel (Breyanzi), Axicabtagene Ciloleucel (Yescarta), Brexucabtagene Autoleucel (Tecartus), Idecabtagene Vicleucel (Abecma), and Tisagenlecleucel (Kymriah). Among them, only Tisagenlecleucel is indicated for the treatment of pediatric and young adults patients with (R/R) B-cell ALL. […] CAR T-cell therapy can help patients whose cancer recurs after several treatments to achieve complete remissions for years. Some patients live for long periods without their cancer progress. Major advantages of CAR T-cell therapies are the low number of infusions needed, short treatment period, and rapid recovery than traditional treatments. […] Although the rate of the primary response to CAR T-cell therapy in B-cell malignancies for relapsed or refractory disease is remarkably effective and is related to a CRi/CR (7490%) in some clinical trials still many patients fail to respond or relapse after the initial treatment. […] A CD22 CAR T-cell clinical study also reported that CAR T-cell administration could provide a suitable complete remission (CR) or CR with incomplete count recovery (CRi) (80%) evaluated after 30 days in this study. Most patients only experienced mild cytokine-release syndrome and neurotoxicity.

• #56 Acute Lymphoblastic Leukemia (ALL): Symptoms, Diagnosis, Treatment, Prognosis, and Survival Rate

  https://www.webmd.com/cancer/lymphoma/acute-lymphoblastic-leukemia

  A stem cell transplant. After high doses of chemotherapy and possibly radiation, you get stem cells that will grow into healthy blood cells. They might be your own or come from a donor. If you cant handle high doses of chemotherapy and radiation, you might get lower doses with a „mini-transplant.” […] About 80% to 90% of adults reach remission after treatment. For about 30% to 40%, the cancer doesnt return. But many relapse, meaning the disease returns. […] Youll need post-remission therapy to keep the cancer from coming back. This involves cycles of treatment over 2 to 3 years. It aims to rid your body of leukemia cells. […] The FDA has also approved a form of treatment called CAR T-cell therapy. It uses some of your own immune cells, called T cells, to treat your cancer. Doctors take the cells out of your blood and add genes to them. The new T cells are better able to find and kill cancer cells.

• #57 Acute lymphocytic leukemia – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/acute-lymphocytic-leukemia/diagnosis-treatment/drc-20369083

  A bone marrow transplant, also known as a stem cell transplant, may be used as consolidation therapy or for treating relapse if it occurs. This procedure allows someone with leukemia to reestablish healthy bone marrow by replacing leukemic bone marrow with leukemia-free marrow from a healthy person. […] A specialized treatment called chimeric antigen receptor (CAR)-T cell therapy takes your body’s germ-fighting T cells, engineers them to fight cancer and infuses them back into your body. […] Clinical trials are experiments to test new cancer treatments and new ways of using existing treatments. While clinical trials give you or your child a chance to try the latest cancer treatment, the benefits and risks of the treatment may be uncertain. Discuss the benefits and risks of clinical trials with your doctor.

• #58 Treatment for acute lymphoblastic leukaemia (ALL leukemia) | Macmillan Cancer Support

  https://www.macmillan.org.uk/cancer-information-and-support/leukaemia/acute-lymphoblastic-leukaemia-all-treatment

  A donor stem cell transplant is an intensive treatment that may increase the chances of curing ALL or keep it in remission for longer. This treatment is not suitable or needed for everyone. […] Treatment for ALL is usually given in 3 main phases. […] Induction phase chemotherapy and other drugs are given to get rid of the leukaemia cells in your blood and bone marrow. […] Consolidation (or intensification) treatment to get rid of any remaining leukaemia cells in areas such as the brain or spinal cord. […] Maintenance phase to reduce the risk of leukaemia coming back. This is also called maintenance therapy. […] During treatment, your doctors and nurses will take blood, bone marrow and lumbar puncture samples to check for leukaemia cells. The results of these tests help doctors: find out how well your treatment is working, see whether the leukaemia is more likely to come back, decide what treatment you may need next to give you the best chance of a cure.

• #59 Patient education: Acute lymphoblastic leukemia (ALL) treatment in adults (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/acute-lymphoblastic-leukemia-all-treatment-in-adults-beyond-the-basics

  Consolidation/intensification therapy – This phase happens after remission has been achieved, and involves more chemotherapy, other medications, and/or stem cell transplantation to prevent a relapse. […] Remission maintenance (or continuation) therapy – This treatment is intended to prevent relapse and involves alternating chemotherapy sessions with oral medications (pills), usually over two to three years. […] Stem cell transplantation, also called bone marrow transplantation or hematopoietic stem cell transplantation, is a treatment in which the patient’s normal source of blood cells (the bone marrow) is replaced by healthy bone marrow cells (called stem cells) from a healthy genetically well-matched donor. […] Allogeneic transplantation uses stem cells from a donor other than the patient, ideally a sibling with a similar genetic makeup (called a matched related donor).

• #60 6 Innovative Acute Lymphocytic Leukemia Treatment Options | MD Anderson Cancer Center

  https://www.mdanderson.org/cancer-types/acute-lymphocytic-leukemia/acute-lymphocytic-leukemia-treatment.html

  Maintenance: In the maintenance phase, patients receive a lower dose of chemotherapy to stop the cancer from returning. ALL patients receive maintenance chemotherapy for about two years. […] A stem cell transplant (also known as a bone marrow transplant) is a procedure that replaces cancerous bone marrow with new, healthy bone marrow stem cells. Stem cell transplants are usually given after an intense round of chemotherapy that kills the patients existing bone marrow cells and prepares the body for transplant. […] A stem cell transplant may be needed for patients whose leukemia has returned or has not responded to standard treatments. It may also be recommended if the patient has a high-risk form of leukemia that would make a cure with standard treatments unlikely. […] In Chimeric Antigen Receptor (CAR) T cell therapy, T cells are modified so they can recognize and attack cancer cells.

• #61 How I treat newly diagnosed acute lymphoblastic leukemia

  https://pmc.ncbi.nlm.nih.gov/articles/PMC11088446/

  The consolidation phase includes alternating courses of chemotherapy, consisting of high doses (HD) of MTX, HD-AraC, CP, etoposide, asparaginase, and dexamethasone. The treatment algorithm may include a re-induction phase, i.e., a repeated course of the drugs used during initial induction. Repeated administration of high doses of polyethylene glycol (PEG)-asparaginase (2000 IU/m2) is a feature of PIR. […] Allo-HCT effectively prevents relapse in ALL adults, combining the conditioning regimens anti-leukemic activity and beneficial graft-versus-leukemia reaction mediated by donor-derived immune cells. Unfortunately, it is associated with a significant risk of non-relapse mortality (NRM) affecting 15-22% of patients, depending on the donor type. Therefore, Ph- ALL allo-HCT in the first CR is considered only for patients with a high estimated risk of relapse.

• #62 How I treat newly diagnosed acute lymphoblastic leukemia

  https://pmc.ncbi.nlm.nih.gov/articles/PMC11088446/

  The consolidation phase includes alternating courses of chemotherapy, consisting of high doses (HD) of MTX, HD-AraC, CP, etoposide, asparaginase, and dexamethasone. The treatment algorithm may include a re-induction phase, i.e., a repeated course of the drugs used during initial induction. Repeated administration of high doses of polyethylene glycol (PEG)-asparaginase (2000 IU/m2) is a feature of PIR. […] Allo-HCT effectively prevents relapse in ALL adults, combining the conditioning regimens anti-leukemic activity and beneficial graft-versus-leukemia reaction mediated by donor-derived immune cells. Unfortunately, it is associated with a significant risk of non-relapse mortality (NRM) affecting 15-22% of patients, depending on the donor type. Therefore, Ph- ALL allo-HCT in the first CR is considered only for patients with a high estimated risk of relapse.

• #63 Evolving therapy of adult acute lymphoblastic leukemia: state-of-the-art treatment and future directions | Journal of Hematology & Oncology | Full Text

  https://jhoonline.biomedcentral.com/articles/10.1186/s13045-020-00905-2

  The goal of therapy in Ph-positive ALL is not only to achieve and maintain CR, but to achieve complete molecular response (CMR) early in the treatment course. […] The optimal duration of TKI therapy is not well-established but is often indefinite (in the absence of unacceptable toxicity) unless allogeneic HSCT is performed, after which most experts recommend post-HSCT TKI maintenance for approximately 1-2 years. […] The advent of MRD assessment has refined the treatment landscape of ALL. […] This has led to the approval of blinatumomab for this indication, the first such approval of an MRD-directed therapy. […] With the development of novel, effective therapies such as InO, blinatumomab, and CAR T cells, our treatment options have not only expanded, but our focus is shifting toward strategies that minimize cytotoxic chemotherapy and HSCT.

• #64 How I treat newly diagnosed acute lymphoblastic leukemia

  https://pmc.ncbi.nlm.nih.gov/articles/PMC11088446/

  The consolidation phase includes alternating courses of chemotherapy, consisting of high doses (HD) of MTX, HD-AraC, CP, etoposide, asparaginase, and dexamethasone. The treatment algorithm may include a re-induction phase, i.e., a repeated course of the drugs used during initial induction. Repeated administration of high doses of polyethylene glycol (PEG)-asparaginase (2000 IU/m2) is a feature of PIR. […] Allo-HCT effectively prevents relapse in ALL adults, combining the conditioning regimens anti-leukemic activity and beneficial graft-versus-leukemia reaction mediated by donor-derived immune cells. Unfortunately, it is associated with a significant risk of non-relapse mortality (NRM) affecting 15-22% of patients, depending on the donor type. Therefore, Ph- ALL allo-HCT in the first CR is considered only for patients with a high estimated risk of relapse.

• #65 Childhood Acute Lymphoblastic Leukemia – NCI

  https://www.cancer.gov/types/leukemia/patient/child-all-treatment-pdq

  Types of treatment for childhood acute lymphoblastic leukemia […] Treatment options depend on: […] Types of treatment your child might have include: […] Chemotherapy (also called chemo) uses drugs to stop the growth of cancer cells. Chemotherapy either kills the cells or stops them from dividing. Chemotherapy may be given alone or with other types of treatment. […] Radiation therapy uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing. Childhood ALL is treated with external beam radiation therapy. […] Stem cell transplant is a treatment to replace the blood-forming cells. […] Immunotherapy is a treatment that uses the patient’s immune system to fight cancer. […] Targeted therapy uses drugs or other substances to block the action of specific enzymes, proteins, or other molecules involved in the growth and spread of cancer cells.

• #66 Acute lymphocytic leukemia – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/acute-lymphocytic-leukemia/diagnosis-treatment/drc-20369083

  Depending on your situation, the phases of treatment for acute lymphocytic leukemia can span two to three years. […] Treatments may include: […] Chemotherapy, which uses drugs to kill cancer cells, is typically used as an induction therapy for children and adults with acute lymphocytic leukemia. Chemotherapy drugs can also be used in the consolidation and maintenance phases. […] Targeted drug treatments focus on specific abnormalities present within cancer cells. By blocking these abnormalities, targeted drug treatments can cause cancer cells to die. Your leukemia cells will be tested to see if targeted therapy may be helpful for you. Targeted therapy can be used alone or in combination with chemotherapy for induction therapy, consolidation therapy or maintenance therapy. […] Radiation therapy uses high-powered beams, such as X-rays or protons, to kill cancer cells. If the cancer cells have spread to the central nervous system, your doctor may recommend radiation therapy.

• #67 Treatment for acute lymphoblastic leukaemia – NHS

  https://www.nhs.uk/conditions/acute-lymphoblastic-leukaemia/treatment/

  Acute lymphoblastic leukaemia (ALL) is often treatable. […] Treatment usually needs to start quickly. […] It will usually include steroids and chemotherapy. It may also include targeted medicines, immunotherapy or a stem cell or bone marrow transplant. […] Steroid medicine aims to get rid of the leukaemia cells. […] Chemotherapy uses medicines to kill cancer cells. It’s the main treatment for acute lymphoblastic leukaemia. […] Targeted medicines aim to stop cancer growing. Immunotherapy is where medicines are used to help the immune system kill cancer. […] A stem cell or bone marrow transplant replaces damaged blood cells with healthy ones. […] You may need to have treatment to prevent or control symptoms caused by acute lymphoblastic leukaemia. […] Sometimes acute lymphoblastic leukaemia might be very hard to treat, and it may not be possible to cure the cancer. […] If this is the case, the aim of treatment will be to limit the cancer and its symptoms, and help you live longer.

• #68 Acute Lymphoblastic Leukemia (ALL): Symptoms, Diagnosis, Treatment, Prognosis, and Survival Rate

  https://www.webmd.com/cancer/lymphoma/acute-lymphoblastic-leukemia

  Targeted therapy. Some drugs target specific parts of cancer cells and tend to have fewer or milder side effects than chemotherapy. They include bosutinib (Bosulif), dasatinib (Sprycel), imatinib (Gleevec), nilotinib (Tasigna), and ponatinib (Iclusig). […] Radiation therapy. Your doctor might use high-energy radiation to kill cancer cells if theyve reached your brain or bone or before you have a stem cell transplant. […] Immunotherapy. These drugs boost your immune system to kill or slow the growth of cancer cells. They include blinatumomab (Blincyto) and inotuzumab ozogamicin (Besponsa). The FDA has also approved a form of treatment called CAR T-cell therapy. It uses some of your own immune cells, called T cells, to treat your cancer. Doctors take the cells out of your blood and add genes to them. The new T cells are better able to find and kill cancer cells.

• #69 Acute Lymphoblastic Leukemia (ALL): Symptoms, Treatment & Prognosis

  https://my.clevelandclinic.org/health/diseases/21564-acute-lymphocytic-leukemia

  Central nervous system-directed therapy to kill any leukemia cells in your central nervous system and keep ALL from spreading to your spinal fluid. (System-directed means you have chemotherapy that affects your entire body or system.) […] Consolidation therapy begins once ALL is in remission. This treatment works to destroy as many remaining cancerous cells as possible. Consolidation therapy involves being in the hospital for several months while you receive high-dose chemotherapy administered weekly. […] Continuation or maintenance therapy is a long-term treatment that may last two to three years. You dont have to be in the hospital to receive maintenance therapy. […] Targeted therapy focuses on specific genetic changes. About 25% of adults and some children with ALL have chromosomal mutations. Healthcare providers currently use tyrosine kinase (TKI) therapy to treat ALL in children and adults with a specific mutation called Philadelphia chromosome or t(9;22). TKI therapy blocks an enzyme essential for ALL growth. TKI therapy kills ALL cells so your body gets back to normal blood cell production.

• #70 What is Acute Lymphocytic Leukemia (ALL)? Symptoms, Risk Factors & Treatments | MD Anderson Cancer Center

  https://www.mdanderson.org/cancer-types/acute-lymphocytic-leukemia.html

  Acute lymphocytic leukemia (ALL) is a cancer of the blood and blood-forming tissues of the body that quickly gets worse when left untreated. […] The Philadelphia chromosome forms when pieces of chromosome 9 and chromosome 22 swap places in a blood cell. […] Leukemias with the Philadelphia chromosome can be treated with targeted therapies called tyrosine kinase inhibitors. These drugs interfere with the tyrosine kinase protein and therefore the multiplication of cancerous white blood cells. […] The best part of immunotherapy was how significantly it shortened my treatment period. […] With immunotherapy, all of my treatment was finished within nine months of my diagnosis, though I’ll continue to take a targeted therapy drug called a tyrosine kinase inhibitor once a day in pill form for another four years.

• #71 How I treat newly diagnosed acute lymphoblastic leukemia

  https://pmc.ncbi.nlm.nih.gov/articles/PMC11088446/

  Treatment algorithms differ for adult patients with Philadelphia-negative (Ph-) and Philadelphia-positive (Ph+) acute lymphoblastic leukemia (ALL). For Ph- ALL intensive induction-consolidation chemotherapy using pediatric-inspired protocols is a standard of care. Allogeneic hematopoietic cell transplantation (allo-HCT) from either an HLA-matched sibling, unrelated or haploidentical donor should be considered for patients with high estimated risk of relapse. Patients with B-ALL and detectable MRD should be treated with blinatumomab. In the future, the use of blinatumomab and/or inotuzumab ozogamycin in addition to first-line chemotherapy may become a new standard of care reducing the role of allo-HCT. For patients with Ph+ ALL, tyrosine kinase inhibitors (TKI) are the most important components of treatment protocols, while the intensity of chemotherapy may be reduced. Allo-HCT is recommended for all patients treated with imatinib along with low-intensity chemotherapy. Results of phase-II studies using front-line dasatinib or ponatinib in sequence or in combination with blinatumomab are very promising. Such a strategy may allow the avoidance of systemic chemotherapy. The future role of allo-HCT in this context appears uncertain.

• #72 What is Acute Lymphocytic Leukemia (ALL)? Symptoms, Risk Factors & Treatments | MD Anderson Cancer Center

  https://www.mdanderson.org/cancer-types/acute-lymphocytic-leukemia.html

  Acute lymphocytic leukemia (ALL) is a cancer of the blood and blood-forming tissues of the body that quickly gets worse when left untreated. […] The Philadelphia chromosome forms when pieces of chromosome 9 and chromosome 22 swap places in a blood cell. […] Leukemias with the Philadelphia chromosome can be treated with targeted therapies called tyrosine kinase inhibitors. These drugs interfere with the tyrosine kinase protein and therefore the multiplication of cancerous white blood cells. […] The best part of immunotherapy was how significantly it shortened my treatment period. […] With immunotherapy, all of my treatment was finished within nine months of my diagnosis, though I’ll continue to take a targeted therapy drug called a tyrosine kinase inhibitor once a day in pill form for another four years.

• #73 How I treat newly diagnosed acute lymphoblastic leukemia

  https://pmc.ncbi.nlm.nih.gov/articles/PMC11088446/

  In recent years, immunotherapy appears increasingly important in addition to chemotherapy for adults with Ph- ALL. […] Blinatumomab, a bispecific anti-CD19/anti-CD3 T-cell enhancer, has been approved for treating patients in CR with MRD levels10-3 in the bone marrow. As shown by the results of the phase II study, it may allow for the eradication of MRD in 78% of patients in the first or subsequent CR. […] The use of modern PIR, incorporating all approved and available drugs, offers a chance of long-term survival to 50-70% of adults with Ph- ALL. […] For patients with Ph+ ALL the use of TKI is a priority. Imatinib in combination with reduced-intensity chemotherapy, followed by allo-HCT is currently recommended. […] Taken together, it seems that the use of second or third generation TKI in combination or in sequence with blinatumomab may markedly improve the prognosis of patients with Ph+ ALL, reducing the role of allo-HCT as part of the first-line treatment.

• #74 How I treat newly diagnosed acute lymphoblastic leukemia | Published in Clinical Hematology International

  https://chi.scholasticahq.com/article/117026-how-i-treat-newly-diagnosed-acute-lymphoblastic-leukemia

  The use of modern PIR, incorporating all approved and available drugs, offers a chance of long-term survival to 50-70% of adults with Ph- ALL. Relapse and transplant-related mortality are the most frequent causes of treatment failure. The outcomes are inferior in older patients due to higher frequency of adverse molecular subtypes, poor tolerance of intensive chemotherapy and ineligibility for myeloablative allo-HCT. […] For patients with Ph+ ALL the use of TKI is a priority. Imatinib in combination with reduced-intensity chemotherapy, followed by allo-HCT is currently recommended. The current treatment standard for adults with Ph+ ALL is presented in the text. The upfront use of second or third generation TKI may contribute to an increased rate of molecular responses. When combined with intensive chemotherapy and/or modern immunotherapy, there is a potential for cure without allo-HCT.

• #75 How I treat newly diagnosed acute lymphoblastic leukemia

  https://pmc.ncbi.nlm.nih.gov/articles/PMC11088446/

  In recent years, immunotherapy appears increasingly important in addition to chemotherapy for adults with Ph- ALL. […] Blinatumomab, a bispecific anti-CD19/anti-CD3 T-cell enhancer, has been approved for treating patients in CR with MRD levels10-3 in the bone marrow. As shown by the results of the phase II study, it may allow for the eradication of MRD in 78% of patients in the first or subsequent CR. […] The use of modern PIR, incorporating all approved and available drugs, offers a chance of long-term survival to 50-70% of adults with Ph- ALL. […] For patients with Ph+ ALL the use of TKI is a priority. Imatinib in combination with reduced-intensity chemotherapy, followed by allo-HCT is currently recommended. […] Taken together, it seems that the use of second or third generation TKI in combination or in sequence with blinatumomab may markedly improve the prognosis of patients with Ph+ ALL, reducing the role of allo-HCT as part of the first-line treatment.

• #76 Typical Treatment of Acute Lymphocytic Leukemia (ALL) | American Cancer Society

  https://www.cancer.org/cancer/types/acute-lymphocytic-leukemia/treating/typical-treatment.html

  If the leukemia is refractory, newer or more intensive doses of chemo drugs may be tried, although they are less likely to work. […] If leukemia goes into remission with the initial treatment but then comes back, it will most often do so in the bone marrow and blood. […] It is sometimes possible to put the leukemia into remission again with more chemotherapy, although this remission tends to be shorter than the first one. […] If a second remission can be achieved, most doctors will advise some type of stem cell transplant if possible. […] At some point, it may become clear that further treatment, even in clinical trials, is extremely unlikely to cure the leukemia. […] This may be called palliative treatment or supportive care.

• #77 Acute Lymphoblastic Leukemia Treatment (PDQ®) – PDQ Cancer Information Summaries – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK65727/

  Sixty percent to 80% of adults with ALL usually achieve a complete remission after appropriate induction therapy. […] In patients with Ph-positive ALL, the remission rate is generally greater than 90% when standard induction regimens are combined with BCR::ABL1 tyrosine kinase inhibitors. […] Patients who experience a relapse after remission usually die within 1 year, even if a second complete remission is achieved. […] Blinatumomab is a bispecific antibody targeting CD19 and CD3. […] Inotuzumab ozogamicin is an antibody-drug conjugate targeting CD22, which contains a conjugated toxin, calicheamicin. […] Patients with Ph-positive ALL are often taking imatinib at the time of relapse and thus have imatinib-resistant disease. […] Revumenib is an oral menin inhibitor that is approved by the FDA for the treatment of relapsed or refractory acute leukemia with a KMT2A translocation in adult and pediatric patients aged 1 year and older.

• #78 Acute Lymphoblastic Leukemia Treatment – NCI

  https://www.cancer.gov/types/leukemia/patient/adult-all-treatment-pdq

  Treatment of recurrent ALL may include: combination chemotherapy followed by stem cell transplant, immunotherapy (blinatumomab or inotuzumab ozogamicin) followed by stem cell transplant, low-dose radiation therapy as palliative care to relieve symptoms and improve quality of life, targeted therapy with dasatinib or revumenib for certain patients, CAR T-cell therapy (brexucabtagene autoleucel or tisagenlecleucel) for certain patients.

• #79 Acute Lymphoblastic Leukemia (ALL) Treatment Protocols: Treatment Protocols

  https://emedicine.medscape.com/article/2004705-overview

  Ph+ ALL in the AYA (age 15-39 y): Chemotherapy plus TKI, followed by allogeneic stem cell transplantation if an appropriate donor is available; if transplantation is not feasible, continue multiagent chemotherapy and a TKI. […] Stem cell transplantation represents the most intensive postremission therapy and potentially increases a patient’s chance for cure. […] The prognosis for patients who experience relapse after front-line therapy is poor, with very few patients surviving long term. The best outcome is obtained if patients achieve a second remission and then proceed to allogeneic stem cell transplantation. […] Most of the chemotherapy regimens used for front-line therapy of ALL can be used in the salvage setting; however, response rates are low and remission durations are short.

• #80 Acute Lymphoblastic Leukemia (ALL) Treatment Protocols: Treatment Protocols

  https://emedicine.medscape.com/article/2004705-overview

  Blinatumomab, a bispecific T-cell engager (BiTE) antibody, is approved for Ph- relapsed or refractory B-cell ALL; treatment cycles consist of 4 weeks continuous IV infusion with at least a 2-week treatment-free interval between cycles. […] CAR T-cell therapy has been approved for treatment of relapsed or refractory B-cell precursor ALL.

• #81 Patient education: Acute lymphoblastic leukemia (ALL) treatment in adults (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/acute-lymphoblastic-leukemia-all-treatment-in-adults-beyond-the-basics

  Treatment of relapsed or resistant disease – A second remission may be attained using a similar induction regimen if the relapse occurs more than two years following initial treatment. […] Several novel anti-leukemia treatments have been approved for specific subtypes of ALL. […] Allogeneic stem cell transplantation is a reasonable option for selected patients with resistant or relapsed disease.

• #82 Acute Lymphoblastic Leukemia Treatment (PDQ®) – PDQ Cancer Information Summaries – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK65727/

  Sixty percent to 80% of adults with ALL usually achieve a complete remission after appropriate induction therapy. […] In patients with Ph-positive ALL, the remission rate is generally greater than 90% when standard induction regimens are combined with BCR::ABL1 tyrosine kinase inhibitors. […] Patients who experience a relapse after remission usually die within 1 year, even if a second complete remission is achieved. […] Blinatumomab is a bispecific antibody targeting CD19 and CD3. […] Inotuzumab ozogamicin is an antibody-drug conjugate targeting CD22, which contains a conjugated toxin, calicheamicin. […] Patients with Ph-positive ALL are often taking imatinib at the time of relapse and thus have imatinib-resistant disease. […] Revumenib is an oral menin inhibitor that is approved by the FDA for the treatment of relapsed or refractory acute leukemia with a KMT2A translocation in adult and pediatric patients aged 1 year and older.

• #83 Treatments for acute lymphoblastic leukemia | Canadian Cancer Society

  https://cancer.ca/en/cancer-information/cancer-types/acute-lymphoblastic-leukemia-all/treatment

  Your healthcare team will create a treatment plan just for you. The plan is based on your health and specific information about the cancer. What you want is also important when planning treatment. When deciding which treatments to offer for acute lymphoblastic leukemia (ALL), your healthcare team will consider: […] Chemotherapy is the main treatment for ALL. Targeted therapy and radiation therapy are sometimes used to treat ALL as well. […] If ALL relapses or doesn’t respond to treatment (called refractory ALL), immunotherapy including monoclonal antibodies may be used. A stem cell transplant may also be given with immunotherapy or used as a treatment on its own. […] Treatment for ALL is different for adults than it is for children. […] Induction treatments for acute lymphoblastic leukemia (ALL) include chemotherapy, targeted therapy and CNS prophylaxis or treatment.

• #84 Acute lymphoblastic leukemia treatment – Leukaemia Foundation

  https://www.leukaemia.org.au/blood-cancer/types-of-blood-cancer/leukaemia/acute-lymphoblastic-leukaemia/treatment/

  Because it progresses quickly, treatment needs to begin soon after ALL is diagnosed. The type of treatment used will depend on a number of factors including the sub-type of ALL, the genetic make-up of the leukaemic cells, your age and your general health. […] Chemotherapy is the main form of treatment for ALL. A combination of drugs, including steroids, is usually given in several cycles with a rest period of a few weeks in between. Initially, the aim of treatment is to destroy leukaemic cells and induce a remission. This means that there is no evidence of leukaemic cells in the blood and bone marrow and that normal blood cell production and blood counts are restored. In some cases, where there is a high risk that the leukaemia will relapse, patients may be offered even more intensive therapy followed by a stem cell transplant.

• #85 Acute Lymphoblastic Leukemia (ALL) Treatment | St. Jude Care & Treatment

  https://www.stjude.org/care-treatment/treatment/childhood-cancer/leukemia-lymphoma/acute-lymphoblastic-leukemia-all.html

  Your child’s oncologist will discuss treatment options with you. […] St. Jude has led the way in how the world treats childhood leukemia since the hospital opened in 1962. […] St. Jude patients with ALL have a 94% survival rate. […] St. Jude investigators showed that radiation can be safely omitted from the treatment of most patients with ALL. […] St. Jude researchers found that there are more than 30 subtypes of ALL. They are based on changes in genes and chromosomes in the leukemia cells. This finding has transformed treatment for ALL. Treatment plans are now based on a child’s subtype and how it responds to specific treatments. […] At St. Jude, children with ALL can take part in clinical trials if they choose. These studies use the most advanced treatments available. Our goal is to improve each child’s chance of cure and to reduce the side effects of treatment.

• #86 Acute Lymphoblastic Leukemia (ALL) in Children – In Treatment | CureSearch

  https://curesearch.org/Acute-Lymphoblastic-Leukemia-In-Treatment/

  Once doctors confirm a diagnosis of leukemia, they will outline a treatment plan. Acute lymphoblastic leukemia is a cancer of the blood, so treatment is systemic, meaning it affects the entire body. At the time of diagnosis, the healthcare team will insert a central line to provide treatment. Chemotherapy is the mainstay of treatment. […] The first phase of treatment usually lasts four weeks. Children receive three or four drugs by mouth, intravenously (into a vein), or into the spinal fluid (intrathecal delivery). The combination of drugs can vary depending on the particular diagnosis. The goal of this phase is to kill the leukemia cells and allow normal blood cells to return. […] The second phase of treatment lasts from 12-16 weeks. Different drugs from those used during Induction are given by mouth and intravenously.

• #87 Acute Lymphoblastic Leukemia (ALL) in Children – In Treatment | CureSearch

  https://curesearch.org/Acute-Lymphoblastic-Leukemia-In-Treatment/

  This eight-week phase of treatment will include the use of the chemotherapy agent methotrexate. Methotrexate is given intravenously, either at lower doses in the clinic or at higher doses that require a 2-3 day stay in the hospital. […] This 8-week phase of treatment includes medicines similar to those given in Induction and Consolidation. This has been shown to be helpful in preventing leukemia from returning. […] The final phase of treatment lasts two or three years. Maintenance is much less intensive than the previous treatment and consists mostly of oral medications given at home. There are also intermittent intravenous and intrathecal medications given throughout this phase. […] Most of the chemotherapy drugs used to treat acute lymphoblastic leukemia don’t get into the brain and spinal fluid very well. Because of this, special approaches have to be used to kill ALL cells in these areas.

• #88 How We Treat Childhood Acute Lymphoblastic Leukemia (ALL) | Dana-Farber Cancer Institute

  https://www.dana-farber.org/cancer-care/types/childhood-acute-lymphoblastic-leukemia/treatment

  Your child’s physician will determine a specific course of treatment for childhood leukemia based on several factors, including: […] Treatment for ALL is a long-term process. Chemotherapy and other treatment for the disease may take two years or more to complete. […] Chemotherapy is the standard first treatment for acute lymphoblastic leukemia (ALL). […] While chemotherapy can be quite effective in treating certain cancers, the medications don’t distinguish healthy cells from cancer cells. […] Radiation therapy uses high-energy rays (radiation) from a specialized machine to damage or kill cancer cells and shrink tumors. […] A stem cell (or bone marrow) transplant is a treatment that is rarely used to treat ALL except for: […] CAR (chimeric antigen receptor) T-cell therapy is a promising new treatment for relapsed or refractory B-cell ALL.

• #89 Acute Lymphoblastic Leukemia (ALL) Treatment | St. Jude Care & Treatment

  https://www.stjude.org/care-treatment/treatment/childhood-cancer/leukemia-lymphoma/acute-lymphoblastic-leukemia-all.html

  Chemotherapy is the main treatment for ALL. It has 3 phases and can take 22.5 years to complete. […] The treatment plan depends on the chance that the leukemia may not respond to treatment or may come back after treatment has finished. This is called risk-based treatment. […] St. Jude groups ALL cases as low risk, standard risk, and high risk. Cases that are most likely to respond to treatment are low risk. Leukemia that is the hardest to treat is high risk. […] Children with low-risk ALL get less medicine than children with standard-risk ALL. Children with high-risk ALL get more medicine than children with standard-risk ALL. They may need more treatments such as immunotherapy or stem cell (bone marrow) transplant. […] For specific types of ALL, children may get targeted therapy or immunotherapy. These therapies help the body identify and kill certain types of cancer cells.

• #90 Adult Acute Lymphoblastic Leukemia

  https://www.texasoncology.com/types-of-cancer/leukemia/adult-acute-lymphoblastic-leukemia

  Adult ALL is a malignant disease or cancer of the blood characterized by the rapid uncontrolled growth of abnormal, immature white blood cells known as lymphoblasts. […] There has been significant progress in treating adult ALL over the past two decades and currently 60-80% of patients will achieve a complete remission following combination chemotherapy induction and 30-40% will become long-term survivors and possibly cured. […] The following is a general overview of the treatment of adult ALL. […] Most new treatments are developed in clinical trials. […] Treatment of adolescents and very young adults with ALL is often carried out using pediatric protocols because of data suggesting better outcomes for this group than when treatment is administered on adult protocols. […] In order to understand the best treatment options available for adult ALL, patients should know whether they have a B-cell or T-cell leukemia, the classification or histologic subtype (L1-L3) of leukemia, the initial white blood cell count, and the results of analyses of chromosomes by cytogenetic examination.

• #91 How I treat newly diagnosed acute lymphoblastic leukemia

  https://pmc.ncbi.nlm.nih.gov/articles/PMC11088446/

  The treatment of adults with ALL traditionally consists of polychemotherapy. It includes several phases: a pre-treatment phase, mainly using glucocorticoids, followed by an induction phase, aimed at achieving complete remission (CR), and a consolidation phase to perpetuate the state of CR. Follow-up is either maintenance therapy or an allogeneic hematopoietic cell transplantation (allo-HCT), which is recommended for patients with a high estimated risk of disease recurrence. […] For patients with Ph- ALL, PIR is a standard of care. A meta-analysis of 25 studies comparing the results of pediatric protocols with those originally designed for adults showed an approximately 20% overall survival advantage at 5 years in favor of the pediatric ones in AYA. Direct implementation of pediatric protocols may be considered for patients up to 40 years old. The treatment intensity should be tapered for individuals between 40 and 55 years old. For those aged 55 years or more, the therapy should be personalized and adjusted to the performance status and comorbidities.

• #92 How I treat newly diagnosed acute lymphoblastic leukemia

  https://pmc.ncbi.nlm.nih.gov/articles/PMC11088446/

  The treatment of adults with ALL traditionally consists of polychemotherapy. It includes several phases: a pre-treatment phase, mainly using glucocorticoids, followed by an induction phase, aimed at achieving complete remission (CR), and a consolidation phase to perpetuate the state of CR. Follow-up is either maintenance therapy or an allogeneic hematopoietic cell transplantation (allo-HCT), which is recommended for patients with a high estimated risk of disease recurrence. […] For patients with Ph- ALL, PIR is a standard of care. A meta-analysis of 25 studies comparing the results of pediatric protocols with those originally designed for adults showed an approximately 20% overall survival advantage at 5 years in favor of the pediatric ones in AYA. Direct implementation of pediatric protocols may be considered for patients up to 40 years old. The treatment intensity should be tapered for individuals between 40 and 55 years old. For those aged 55 years or more, the therapy should be personalized and adjusted to the performance status and comorbidities.

• #93 How I treat newly diagnosed acute lymphoblastic leukemia | Published in Clinical Hematology International

  https://chi.scholasticahq.com/article/117026-how-i-treat-newly-diagnosed-acute-lymphoblastic-leukemia

  For patients with Ph- ALL, PIR is a standard of care. A meta-analysis of 25 studies comparing the results of pediatric protocols with those originally designed for adults showed an approximately 20% overall survival advantage at 5 years in favor of the pediatric ones in AYA. Direct implementation of pediatric protocols may be considered for patients up to 40 years old. The treatment intensity should be tapered for individuals between 40 and 55 years old. For those aged 55 years or more, the therapy should be personalized and adjusted to the performance status and comorbidities. […] The pre-treatment phase is usually based on glucocorticosteroids, mainly dexamethasone +/- cyclophosphamide (CP), administered for 5-7 days. After the initial reduction of the tumor burden, induction therapy is initiated, usually consisting of anthracyclines, vincristine (VCR), dexamethasone, and asparaginase. It may be followed by a second course, including CP, cytosine arabinoside (AraC), mercaptopurine, and methotrexate (MTX). CR is achieved in approximately 90% of patients. The consolidation phase includes alternating courses of chemotherapy, consisting of high doses (HD) of MTX, HD-AraC, CP, etoposide, asparaginase, and dexamethasone. The treatment algorithm may include a re-induction phase, i.e., a repeated course of the drugs used during initial induction. Repeated administration of high doses of polyethylene glycol (PEG)-asparaginase (2000 IU/m2) is a feature of PIR.

• #94 How I treat newly diagnosed acute lymphoblastic leukemia | Published in Clinical Hematology International

  https://chi.scholasticahq.com/article/117026-how-i-treat-newly-diagnosed-acute-lymphoblastic-leukemia

  For patients with Ph- ALL, PIR is a standard of care. A meta-analysis of 25 studies comparing the results of pediatric protocols with those originally designed for adults showed an approximately 20% overall survival advantage at 5 years in favor of the pediatric ones in AYA. Direct implementation of pediatric protocols may be considered for patients up to 40 years old. The treatment intensity should be tapered for individuals between 40 and 55 years old. For those aged 55 years or more, the therapy should be personalized and adjusted to the performance status and comorbidities. […] The pre-treatment phase is usually based on glucocorticosteroids, mainly dexamethasone +/- cyclophosphamide (CP), administered for 5-7 days. After the initial reduction of the tumor burden, induction therapy is initiated, usually consisting of anthracyclines, vincristine (VCR), dexamethasone, and asparaginase. It may be followed by a second course, including CP, cytosine arabinoside (AraC), mercaptopurine, and methotrexate (MTX). CR is achieved in approximately 90% of patients. The consolidation phase includes alternating courses of chemotherapy, consisting of high doses (HD) of MTX, HD-AraC, CP, etoposide, asparaginase, and dexamethasone. The treatment algorithm may include a re-induction phase, i.e., a repeated course of the drugs used during initial induction. Repeated administration of high doses of polyethylene glycol (PEG)-asparaginase (2000 IU/m2) is a feature of PIR.

• #95 Acute lymphocytic leukemia – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/acute-lymphocytic-leukemia/diagnosis-treatment/drc-20369083

  Older adults, such as those older than 65, tend to experience more complications from treatments. And older adults generally have a worse prognosis than children who are treated for acute lymphocytic leukemia. […] Some people may choose to forgo treatment for the cancer, instead focusing on treatments that improve their symptoms and help them make the most of the time they have remaining.

• #96 B-Cell Acute Lymphoblastic Leukemia: Symptoms, Treatment, and Outlook

  https://www.healthline.com/health/leukemia/b-cell-acute-lymphoblastic-leukemia

  Chimeric antigen receptor (CAR)-T cell therapy. CAR-T cell therapy is a treatment that works with your bodys T-cells to get them to fight the cancer cells. This treatment is generally used in children and young adults. […] There are also experimental treatments and clinical trials available for B-cell acute lymphoblastic leukemia. […] Your treatment might look different if youre 65 or older. Adults in this age group may not respond as well to chemotherapy and other standard treatments for B-cell acute lymphoblastic leukemia. […] The outlook for B-cell acute lymphoblastic leukemia is improving as new treatments become available and doctors gain a better understanding of the condition.

• #97 Treating Acute Lymphocytic Leukemia (ALL) | American Cancer Society

  https://www.cancer.org/cancer/types/acute-lymphocytic-leukemia/treating.html

  In most cases ALL can progress quickly if not treated, so it’s important to start treatment as soon as possible after the diagnosis is made. […] Clinical trials are carefully controlled research studies that are done to get a closer look at promising new treatments or procedures. Clinical trials are one way to get state-of-the-art cancer treatment. […] You may hear about alternative or complementary methods to relieve symptoms or treat your cancer that your doctors haven’t mentioned. […] Be sure to talk to your cancer care team about any method you are thinking about using. They can help you learn what is known (or not known) about the method, which can help you make an informed decision. […] Whether you are thinking about treatment, getting treatment, or not being treated at all, you can still get supportive care to help with pain or other symptoms.

• #98 6 Innovative Acute Lymphocytic Leukemia Treatment Options | MD Anderson Cancer Center

  https://www.mdanderson.org/cancer-types/acute-lymphocytic-leukemia/acute-lymphocytic-leukemia-treatment.html

  For ALL, CAR T cell therapy is a treatment option for patients who have been treated unsuccessfully with other therapies. […] MD Anderson offers multiple clinical trials for ALL. Many of these cannot be found anywhere else. Trials explore new drug combinations and new drugs, including targeted therapies and immunotherapies.

• #99 https://www.lls.org/leukemia/acute-lymphoblastic-leukemia/treatment

  https://www.lls.org/leukemia/acute-lymphoblastic-leukemia/treatment

  It’s important that your doctor is experienced in treating patients with acute leukemia or has access to an acute lymphoblastic leukemia (ALL) specialist. […] Doctors use several types of approaches and treatment combinations for ALL: […] Clinical trials can involve therapy with new drugs and new drug combinations or new approaches to stem cell transplantation. […] Patients who have ALL need treatment as soon as possible after diagnosis. […] The approach for treating each patient is based on an individuals subtype, risk factors and treatment goals. […] The treatment your doctor recommends is based on several factors. […] Some things that may affect the outcome of your ALL treatment are […] As you develop a treatment plan with your doctor, be sure to discuss […] Before you start treatment, your doctor will perform tests to learn more about your overall health and your leukemia, including determining whether the leukemia has spread to other parts of the body.

• #100 How We Treat Acute Lymphoblastic Leukemia | Dana-Farber Cancer Institute

  https://www.dana-farber.org/cancer-care/types/acute-lymphoblastic-leukemia/treatment

  Your care will include the latest and best treatments available, including clinical trials of new therapies based on research in our laboratories and elsewhere in the field. We have tailored treatment plans for both young adults and older adults. You also have the full range of support services from a top-ranked hospital and leading cancer research center. Patients with ALL should begin treatment soon after their diagnosis. Call 617-632-6028 to schedule an appointment with one of our leukemia specialists. Treatment for Adults with Acute Lymphoblastic Leukemia Marlise Luskin, MD, MSCE, a leukemia specialist in our Adult Leukemia Program, describes treatment for adults with acute lymphoblastic leukemia (ALL). She explains treatment considerations for younger adults and older adults with ALL. ALL is a rare disease with unique and complicated treatments. Our clinicians offer expertise in selecting treatment, monitoring response, and managing side effects for patients of all ages and disease subtypes. We believe most young adult patients with ALL should receive a pediatric-type chemotherapy regimen. Dana-Farber researchers pioneered this approach which has improved outcomes for adults aged 18 to 50 compared to what has historically been achieved using „adult” treatment protocols. We also recommend that all young patients enroll on a clinical trial when possible. Older adults with ALL may experience more side effects from treatment. We have clinical trials studying novel, less-toxic approaches to treating ALL in older adults. This subtype of ALL is treated with a targeted therapy called a tyrosine kinase inhibitor (TKI). We offer a clinical trial of a novel TKI approach for this disease subtype. Patients with this subtype are often considered for stem cell transplant. ALL that has come back or not responded to prior therapy can be a challenging disease to treat. Our experts have experience with this clinical situation and a number of trials are available testing novel therapies and CAR T-cells. Treatment for ALL is often a long-term process. Chemotherapy and other treatment may take two years or longer to complete. The treatment of adult ALL is usually done in the following phases: Remission Induction Therapy This first phase of treatment for newly-diagnosed ALL patients generally lasts 3 to 4 weeks. The specific treatment plan depends on age and ALL disease subtype, and may include chemotherapy, antibody-based immunotherapy, and/or a targeted therapy called a tyrosine kinase inhibitor (TKI). The goal of induction is to kill the leukemia cells in the blood and bone marrow to put the cancer into remission. After a patient achieves remission, we determine next steps for treatment based on your age, ALL disease subtype, and level of response to initial therapy. Post-Remission Therapy (also called consolidation and maintenance therapy) Leukemia cells may remain after achieving an initial remission. Therefore, the goal in this phase which generally lasts for up to two years is to eliminate remaining leukemia cells that may not be active but could begin to regrow. Central Nervous System Prophylaxis Because ALL cells can migrate to the brain or spinal cord, special treatment must be administered to prevent ALL from recurring in this area. Treatment typically consists of multiple spinal taps and administration of chemotherapy. Some patients may also receive radiation to the brain. Some patients require allogeneic stem cell transplant as part of their post-remission or consolidation treatment or as part of treatment for relapsed disease. With an allogeneic stem cell transplant, patients receive stem cells from a related or unrelated donor to develop a new immune system. Our Program operates a large and growing research program. We are actively engaged in leukemia clinical trials, leading to new therapies and aiming for more cures. We offer clinical trials for: Newly-diagnosed patients, Relapsed patients, Young adults (18-50 years), Older adults, ALL with specific characteristics such as T-cell ALL, or ALL with the Philadelphia chromosome. We are also exploring cellular therapy approaches such as CAR T-cell therapy for patients who have relapsed after intensive chemotherapy or a stem cell transplant. As a highly specialized Center within Dana-Farber Brigham Cancer Center’s Center for Hematologic Oncology, we focus on the distinct needs of patients with leukemia. We provide a very personalized approach to your care. We view every patient as an individual, with unique needs and expectations. We involve you and your family at each step of the treatment process. One of our experienced leukemia physicians will oversee all aspects of your care, both inpatient and outpatient. Because adult acute lymphoblastic leukemia is relatively uncommon, we believe there is great value in adults with suspected or diagnosed ALL consulting with our team of experienced clinicians. Reasons to consider a consultation or second opinion include: If you have received a diagnosis elsewhere and want to be treated at Dana-Farber Brigham Cancer Center. To confirm your diagnosis. To learn if you are eligible for a clinical trial. To determine the optimal therapy and timing of treatment. To determine if you should consider allogeneic stem cell transplant. To learn more about your cancer from specialists who are world leaders in this disease, and who have treated hundreds of other patients like you.

• #101 Treatment for Acute Lymphocytic Leukemia (ALL) | Memorial Sloan Kettering Cancer Center

  https://www.mskcc.org/cancer-care/types/leukemias/treatment/acute-lymphocytic-leukemia

  During the maintenance phase, you may receive lower doses of drugs but for long periods of time, typically two years. This will destroy any remaining leukemia cells. […] CAR T cell therapy is an exciting and powerful new treatment for certain people up to age 25 whose ALL has stopped responding to other therapies. […] If you have been diagnosed with Philadelphia-positive ALL (Ph-Positive ALL), you may receive certain targeted therapies that have proven particularly effective against this subtype of the disease. […] Our doctors are experienced in preventing or controlling central nervous system involvement. We may administer chemotherapy directly to the fluid around the spinal cord and brain. This procedure is called intrathecal chemotherapy. […] Our researchers are constantly pursuing new ways to treat ALL. These approaches can kill tumor cells directly, slow down the body’s production of substances that promote their growth, or enhance the immune response against the leukemia cells. […] Some of the newer combination chemotherapy approaches that were evaluating in adults are inspired by innovative treatments developed for children with ALL. These treatments may be more effective than existing standard therapies.

• #102 Medication for Acute Lymphoblastic Leukemia | NYU Langone Health

  https://nyulangone.org/conditions/acute-lymphoblastic-leukemia/treatments/medication-for-acute-lymphoblastic-leukemia

  Induction chemotherapy is the first phase of conventional chemotherapy treatment for acute lymphoblastic leukemia. […] Common chemotherapy drugs used during this phase include vincristine, cyclophosphamide, and doxorubicin. […] Doctors may add a targeted medication called dasatinib to chemotherapy if genetic testing shows the lymphoblasts have a BCRABL fusion gene. […] The goal of the induction phase is to put the disease into remission, meaning acute lymphoblastic leukemia is no longer found in the blood or bone marrow and the signs and symptoms disappear. […] Even if the condition goes into remission, lymphoblasts can still be present in microscopic amounts in the body. This is called minimal residual disease. […] This treatment is called consolidation therapy, which may be followed by maintenance therapy to prevent recurrence.

• #103 Acute Lymphoblastic Leukemia (ALL): Practice Essentials, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/207631-overview

  Ph+ ALL […] ALL in older children and younger adults […] Relapsed ALL […] ALL in patients with hyperuricemia or at high risk for tumor lysis syndrome […] See Treatment and Medication for more detail. […] The addition of tyrosine kinase inhibitors to chemotherapy has resulted in improved prognosis of patients with Philadelphia chromosomepositive ALL such that many experts no longer consider these patients poor risk. […] The presence of such MRD after treatment is a strong predictor for relapse. […] Routine use of next-generation sequencing and other molecular methods is identifying recurrent genetic abnormalities with prognostic implications. […] Further studies correlating genomic and clinical findings are ongoing. These studies will determine the prognostic implication of specific molecular findings and could allow for the development of targeted agents in these diseases.

• #104 Adult Acute Lymphocytic Leukemia (ALL): Types and Treatment | OncoLink

  https://www.oncolink.org/cancers/blood-cancers/leukemia-acute-lymphocytic-leukemia-all/adult-acute-lymphocytic-leukemia-all-types-and-treatment

  The use of stem cell transplant for ALL is not completely clear. It is often used early in therapy for patients with high-risk ALL subtypes in their first remission. […] Measurable or minimal residual disease (MRD) testing is used to see if the cancer treatment is working and to guide further treatment plans. […] The most effective therapy to prevent CNS disease in adults with ALL is intrathecal chemotherapy.

• #105 Evolving therapy of adult acute lymphoblastic leukemia: state-of-the-art treatment and future directions | Journal of Hematology & Oncology | Full Text

  https://jhoonline.biomedcentral.com/articles/10.1186/s13045-020-00905-2

  The goal of therapy in Ph-positive ALL is not only to achieve and maintain CR, but to achieve complete molecular response (CMR) early in the treatment course. […] The optimal duration of TKI therapy is not well-established but is often indefinite (in the absence of unacceptable toxicity) unless allogeneic HSCT is performed, after which most experts recommend post-HSCT TKI maintenance for approximately 1-2 years. […] The advent of MRD assessment has refined the treatment landscape of ALL. […] This has led to the approval of blinatumomab for this indication, the first such approval of an MRD-directed therapy. […] With the development of novel, effective therapies such as InO, blinatumomab, and CAR T cells, our treatment options have not only expanded, but our focus is shifting toward strategies that minimize cytotoxic chemotherapy and HSCT.

• #106 How I treat newly diagnosed acute lymphoblastic leukemia

  https://pmc.ncbi.nlm.nih.gov/articles/PMC11088446/

  In recent years, immunotherapy appears increasingly important in addition to chemotherapy for adults with Ph- ALL. […] Blinatumomab, a bispecific anti-CD19/anti-CD3 T-cell enhancer, has been approved for treating patients in CR with MRD levels10-3 in the bone marrow. As shown by the results of the phase II study, it may allow for the eradication of MRD in 78% of patients in the first or subsequent CR. […] The use of modern PIR, incorporating all approved and available drugs, offers a chance of long-term survival to 50-70% of adults with Ph- ALL. […] For patients with Ph+ ALL the use of TKI is a priority. Imatinib in combination with reduced-intensity chemotherapy, followed by allo-HCT is currently recommended. […] Taken together, it seems that the use of second or third generation TKI in combination or in sequence with blinatumomab may markedly improve the prognosis of patients with Ph+ ALL, reducing the role of allo-HCT as part of the first-line treatment.

• #107 Azthena logo with the word Azthena

  https://www.news-medical.net/health/Acute-Lymphoblastic-Leukemia-Treatment.aspx

  Acute leukemia is an aggressive condition that needs rapid diagnosis and treatment within a few days after detection. […] Usually a multi-disciplinary team is employed to treat ALL. The team includes an oncologist (cancer specialist), an haematologist (one who specializes in blood and related disorders), a pathologist, a radiotherapist, a neurologist (if there is involvement of the central nervous system), a paediatrician (childhood disease specialists since ALL is common among children), a social worker, a clinical oncology nurse, and a counsellor. […] Treatment is given in three main phases. These include: Induction this forms the initial phase of treatment and is employed to kill the leukaemia cells within the bone marrow. This helps the cells of the blood to normalize and relives symptoms of the cancer.

• #108 Acute Lymphoblastic Leukemia (ALL) Treatment | St. Jude Care & Treatment

  https://www.stjude.org/care-treatment/treatment/childhood-cancer/leukemia-lymphoma/acute-lymphoblastic-leukemia-all.html

  Our clinical trials are based on years of experience and success. We have helped set the standard for ALL treatment, advancing cure rates, and improving the understanding of the disease. […] Our team includes doctors trying to cure the disease and experts in nutrition, rehabilitation, nursing, education, psychology, social work, and child life. This team supports each child through diagnosis, treatment, and recovery.

• #109 Acute Lymphoblastic Leukemia Expertise | UVA Health

  https://uvahealth.com/services/blood-cancer/acute-lymphoblastic-leukemia

  Acute lymphoblastic leukemia (ALL) takes a toll. It can cause weakness, pain, fever, and night sweats. You may also feel afraid of the next steps. Will you get the right care? You want effective treatment from experts you can trust. […] At UVA Health, we have decades of acute lymphoblastic leukemia treatment experience. It’s not just about medical treatment. We’re here to support and care for your symptoms, recovery, and every part of your cancer journey. […] We’re part of an NCI-designated comprehensive cancer center. That means our providers have specific training and experience with ALL leukemia. We provide: Treatment and care by compassionate doctors and nurses, Support services from nurse coordinators, social workers, physical therapists, pharmacists, and dietitians, Expertise in heart conditions, infectious disease, and critical care.

• #110 Acute Lymphoblastic Leukemia (ALL) | Conditions | UCSF Health

  https://www.ucsfhealth.org/conditions/acute-lymphoblastic-leukemia

  The most common induction chemotherapy drugs used for ALL are daunorubicin, vincristine, prednisone, asparaginase and sometimes cyclophosphamide. During this phase, patients receive intensive supportive care, including transfusion of red blood cells and platelets. Antibiotics and anti-fungal medications are used to treat and prevent both bacterial and fungal infections. A medication known as G-CSF (Neupogen) can be used to help quickly reestablish a normal white blood count. […] […] Once blood counts have returned to normal, another bone marrow biopsy is performed to determine if the patient has entered complete remission. A complete remission is achieved when the blood and bone marrow show no evidence of persistent leukemia and blood counts have returned to normal. […] […] Chemotherapy drugs used during consolidation include the same ones used during induction, as well as Ara-C, etoposide, methotrexate and 6-mercaptopurine. The consolidation phase typically includes multiple cycles of intensive chemotherapy given over a six- to nine-month period. Frequent hospitalizations and intensive supportive care are still needed, including red blood cell and platelet transfusions. […]

• #111 Acute Lymphoblastic Leukemia (ALL) – Hematology and Oncology – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/hematology-and-oncology/leukemias/acute-lymphoblastic-leukemia-all

  For patients with Philadelphia chromosomepositive (Ph+) ALL, a tyrosine kinase inhibitor (eg, imatinib, dasatinib) can be added to the drug regimen. […] The goal of consolidation is to prevent leukemic regrowth. […] Most regimens include maintenance therapy with monthly vincristine, weekly methotrexate, daily mercaptopurine, and 5 days/month corticosteroid. […] CNS prophylaxis starts during induction and continues throughout all phases of treatment. […] Supportive care is similar in the acute leukemias and may include transfusions, antimicrobials, hydration and urine alkalinization, and psychologic support. […] Stem cell transplantation following reinduction chemotherapy or immunotherapy offers the greatest hope of long-term remission or cure if an HLA-matched sibling is available.

• #112 https://www.lls.org/leukemia/acute-lymphoblastic-leukemia/treatment/treatment-outcomes

  https://www.lls.org/leukemia/acute-lymphoblastic-leukemia/treatment/treatment-outcomes

  Acute Lymphoblastic Leukemia […] Treatment […] Chemotherapy […] Stem Cell Transplantation […] Ph-Positive ALL Therapy […] Clinical Trials […] Side Effects […] Treatment Outcomes […] Relapsed and Refractory […] Follow-Up Care […] The cure rates and survival outcomes for patients with ALL have improved over the past few decades. Today, nearly 90 percent of adults diagnosed with ALL achieve a complete remission, which means that leukemia cells can no longer be seen in the bone marrow with a microscope. Still, despite high remission rates, relapses still commonly occur in adults and survival rates for adult patients remain at approximately 20 to 40 percent. However, these rates can vary significantly, depending on the patients ALL subtype and other prognostic factors. […] Treatment results and outcomes vary among patients. Newer treatment therapies, progress in stem cell transplantation, better supportive care and studies of new drugs in clinical trials are all contributing to improved outcomes and quality of life for people diagnosed with blood cancers.

• #113 Acute lymphoblastic leukaemia – Symptoms, diagnosis and treatment | BMJ Best Practice

  https://bestpractice.bmj.com/topics/en-gb/273

  Treatment uses multi-agent chemotherapy-based regimens in induction, consolidation, and maintenance phases. […] Allogeneic stem cell transplantation (SCT) is considered in selected patients. […] Salvage chemotherapy, immunotherapy, and SCT are options for relapsed, refractory, or residual disease. […] Despite the aggressive treatment approach, only 40% to 60% of adults with ALL are cured. […] Long-term adverse effects of treatment include heart failure, sterility, secondary malignancies, and neurotoxicity.

• #114 https://www.lls.org/leukemia/acute-lymphoblastic-leukemia/treatment/treatment-outcomes

  https://www.lls.org/leukemia/acute-lymphoblastic-leukemia/treatment/treatment-outcomes

  Acute Lymphoblastic Leukemia […] Treatment […] Chemotherapy […] Stem Cell Transplantation […] Ph-Positive ALL Therapy […] Clinical Trials […] Side Effects […] Treatment Outcomes […] Relapsed and Refractory […] Follow-Up Care […] The cure rates and survival outcomes for patients with ALL have improved over the past few decades. Today, nearly 90 percent of adults diagnosed with ALL achieve a complete remission, which means that leukemia cells can no longer be seen in the bone marrow with a microscope. Still, despite high remission rates, relapses still commonly occur in adults and survival rates for adult patients remain at approximately 20 to 40 percent. However, these rates can vary significantly, depending on the patients ALL subtype and other prognostic factors. […] Treatment results and outcomes vary among patients. Newer treatment therapies, progress in stem cell transplantation, better supportive care and studies of new drugs in clinical trials are all contributing to improved outcomes and quality of life for people diagnosed with blood cancers.

• #115 Acute Lymphoblastic Leukaemia (ALL): Signs & Treatments

  https://cfch.com.sg/acute-lymphoblastic-leukaemia-all/

  Patients with ALL usually need to commence some form of treatment soon after initial diagnosis so as to stabilise the disease and prevent the development of adverse effects. Once the diagnosis is firmly established, it is recommended that patients commence proper ALL treatment as soon as possible. […] Modern-day treatments mean that 80-90% of children are alive and well at 5 years with current protocols. The 5-year overall survival is approximately 65% for adolescents, 40% for adults, and 15-20% for older patients. […] CAR T-cell therapy is a form of immunotherapy that involves collecting a patient’s immune cells and modifying them in a laboratory to target specific cancer cells. These modified cells are then returned to the patient to strengthen their immune system against the cancer cells. It may be used in the treatment of Acute Lymphoblastic Leukaemia when two prior treatment options have proven unsuccessful.

• #116 Acute Lymphoblastic Leukaemia (ALL): Signs & Treatments

  https://cfch.com.sg/acute-lymphoblastic-leukaemia-all/

  Patients with ALL usually need to commence some form of treatment soon after initial diagnosis so as to stabilise the disease and prevent the development of adverse effects. Once the diagnosis is firmly established, it is recommended that patients commence proper ALL treatment as soon as possible. […] Modern-day treatments mean that 80-90% of children are alive and well at 5 years with current protocols. The 5-year overall survival is approximately 65% for adolescents, 40% for adults, and 15-20% for older patients. […] CAR T-cell therapy is a form of immunotherapy that involves collecting a patient’s immune cells and modifying them in a laboratory to target specific cancer cells. These modified cells are then returned to the patient to strengthen their immune system against the cancer cells. It may be used in the treatment of Acute Lymphoblastic Leukaemia when two prior treatment options have proven unsuccessful.

• #117 Acute Lymphoblastic Leukemia (ALL): Symptoms, Treatment & Prognosis

  https://my.clevelandclinic.org/health/diseases/21564-acute-lymphocytic-leukemia

  Healthcare providers may treat ALL with long-term chemotherapy, targeted therapy, immunotherapy or stem cells (bone marrow) transplantation. Adults and children with ALL may receive different types of cancer drugs and treatments. […] Providers use chemotherapy as initial or front-line treatment for ALL. People with ALL receive chemotherapy in four phases. The treatment goal is to put ALL into complete remission. (Complete remission means treatment eliminates your symptoms, and tests show no sign of cancer.) […] Chemotherapy for ALL takes place over several months and sometimes years, and typically involves high doses of cancer-killing drugs. People receiving chemotherapy for ALL should consider palliative care to help manage treatment side effects. ALL chemotherapy includes: […] Remission induction therapy, which destroys as many leukemia cells as possible, so ALL goes into complete remission. Typically, people remain in the hospital during remission induction therapy. This treatment takes place over four to six weeks. Studies show more than 95% of children and 75% to 80% of adults with ALL will have complete remission after remission induction therapy.

• #118 https://www.lls.org/leukemia/acute-lymphoblastic-leukemia/treatment/treatment-outcomes

  https://www.lls.org/leukemia/acute-lymphoblastic-leukemia/treatment/treatment-outcomes

  Acute Lymphoblastic Leukemia […] Treatment […] Chemotherapy […] Stem Cell Transplantation […] Ph-Positive ALL Therapy […] Clinical Trials […] Side Effects […] Treatment Outcomes […] Relapsed and Refractory […] Follow-Up Care […] The cure rates and survival outcomes for patients with ALL have improved over the past few decades. Today, nearly 90 percent of adults diagnosed with ALL achieve a complete remission, which means that leukemia cells can no longer be seen in the bone marrow with a microscope. Still, despite high remission rates, relapses still commonly occur in adults and survival rates for adult patients remain at approximately 20 to 40 percent. However, these rates can vary significantly, depending on the patients ALL subtype and other prognostic factors. […] Treatment results and outcomes vary among patients. Newer treatment therapies, progress in stem cell transplantation, better supportive care and studies of new drugs in clinical trials are all contributing to improved outcomes and quality of life for people diagnosed with blood cancers.

• #119 Acute Lymphoblastic Leukemia Treatment (PDQ®): Treatment – Health Professional Information [NCI] | Kaiser Permanente

  https://healthy.kaiserpermanente.org/health-wellness/health-encyclopedia/he.acute-lymphoblastic-leukemia-treatment-pdq%C2%AE-treatment-health-professional-information-nci.ncicdr0000062864

  Sixty percent to 80% of adults with ALL usually achieve a complete remission following appropriate induction therapy. Appropriate initial treatment, usually consisting of a regimen that includes the combination of vincristine, prednisone, and an anthracycline, with or without asparaginase, results in a complete response rate of up to 80%. In patients with Ph-positive ALL, the remission rate is generally greater than 90% when standard induction regimens are combined with BCR::ABL tyrosine kinase inhibitors. […] Patients with ALL who experience a relapse following chemotherapy and maintenance therapy are unlikely to be cured by further chemotherapy alone. These patients should be considered for reinduction chemotherapy followed by allogeneic BMT. […] Blinatumomab is a bispecific antibody targeting CD19 and CD3. The U.S. Food and Drug Administration (FDA) has approved blinatumomab for use in patients with relapsed or refractory B-cell ALL.

• #120 Treatment for acute lymphoblastic leukaemia (ALL leukemia) | Macmillan Cancer Support

  https://www.macmillan.org.uk/cancer-information-and-support/leukaemia/acute-lymphoblastic-leukaemia-all-treatment

  A donor stem cell transplant is an intensive treatment that may increase the chances of curing ALL or keep it in remission for longer. This treatment is not suitable or needed for everyone. […] Treatment for ALL is usually given in 3 main phases. […] Induction phase chemotherapy and other drugs are given to get rid of the leukaemia cells in your blood and bone marrow. […] Consolidation (or intensification) treatment to get rid of any remaining leukaemia cells in areas such as the brain or spinal cord. […] Maintenance phase to reduce the risk of leukaemia coming back. This is also called maintenance therapy. […] During treatment, your doctors and nurses will take blood, bone marrow and lumbar puncture samples to check for leukaemia cells. The results of these tests help doctors: find out how well your treatment is working, see whether the leukaemia is more likely to come back, decide what treatment you may need next to give you the best chance of a cure.

• #121 Acute lymphoblastic leukaemia – Symptoms, diagnosis and treatment | BMJ Best Practice

  https://bestpractice.bmj.com/topics/en-gb/273

  Treatment uses multi-agent chemotherapy-based regimens in induction, consolidation, and maintenance phases. […] Allogeneic stem cell transplantation (SCT) is considered in selected patients. […] Salvage chemotherapy, immunotherapy, and SCT are options for relapsed, refractory, or residual disease. […] Despite the aggressive treatment approach, only 40% to 60% of adults with ALL are cured. […] Long-term adverse effects of treatment include heart failure, sterility, secondary malignancies, and neurotoxicity.

• #122 Treatment for acute lymphoblastic leukaemia (ALL)

  https://www.cancerresearchuk.org/about-cancer/acute-lymphoblastic-leukaemia-all/treatment

  You may have immunotherapy or a targeted cancer drug to help treat some types of ALL. Targeted cancer drugs work by targeting the differences in cancer cells that help them to grow and survive. Immunotherapy, such as CAR T-cell therapy uses the immune system to attack the cancer. […] You might have a stem cell transplant as part of your treatment for ALL. In ALL, you have the stem cells from someone else (a donor). This is called an allogeneic transplant. […] Leukaemia that does not go away with treatment is called refractory leukaemia. If it comes back after treatment it is called relapsed disease. […] Treatment for acute lymphoblastic leukaemia (ALL) might cause short and long term side effects. Short term side effects happen during treatment or very soon after you finish. Long term side effects can develop weeks, months or years after treatment has ended. […] You have follow up appointments and tests after treatment for ALL to check how you are and monitor any side effects or symptoms.

• #123 Treatment for acute lymphoblastic leukaemia (ALL leukemia) | Macmillan Cancer Support

  https://www.macmillan.org.uk/cancer-information-and-support/leukaemia/acute-lymphoblastic-leukaemia-all-treatment

  A donor stem cell transplant is an intensive treatment that may increase the chances of curing ALL or keep it in remission for longer. This treatment is not suitable or needed for everyone. […] Treatment for ALL is usually given in 3 main phases. […] Induction phase chemotherapy and other drugs are given to get rid of the leukaemia cells in your blood and bone marrow. […] Consolidation (or intensification) treatment to get rid of any remaining leukaemia cells in areas such as the brain or spinal cord. […] Maintenance phase to reduce the risk of leukaemia coming back. This is also called maintenance therapy. […] During treatment, your doctors and nurses will take blood, bone marrow and lumbar puncture samples to check for leukaemia cells. The results of these tests help doctors: find out how well your treatment is working, see whether the leukaemia is more likely to come back, decide what treatment you may need next to give you the best chance of a cure.

• #124 Acute Lymphoblastic Leukemia – Seattle Children’s Hospital

  https://www.seattlechildrens.org/conditions/leukemia-all/

  Follow-up care is important after treatment ends. […] To have the best chance of a cure, your child needs care from top experts experienced in treating ALL in children and young adults. […] Most children are cured of ALL with standard treatments. But in about 15% of children, ALL does not respond to treatment (refractory) or comes back (relapsed). […] In addition to standard diagnostics, our team uses state-of-the-art tests like molecular profiling and next-generation sequencing (NGS). […] We know that teens and young adults with cancer have different challenges than young children. […] Our Cancer Survivor Program provides long-term follow-up care to help children and young adults stay healthy after being treated for cancer in childhood.

• #125 Acute Lymphoblastic Leukemia – Seattle Children’s Hospital

  https://www.seattlechildrens.org/conditions/leukemia-all/

  Follow-up care is important after treatment ends. […] To have the best chance of a cure, your child needs care from top experts experienced in treating ALL in children and young adults. […] Most children are cured of ALL with standard treatments. But in about 15% of children, ALL does not respond to treatment (refractory) or comes back (relapsed). […] In addition to standard diagnostics, our team uses state-of-the-art tests like molecular profiling and next-generation sequencing (NGS). […] We know that teens and young adults with cancer have different challenges than young children. […] Our Cancer Survivor Program provides long-term follow-up care to help children and young adults stay healthy after being treated for cancer in childhood.

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