Acute lymphoblastic leukaemia
Acute lymphoblastic leukaemia is the childhood cancer success story, and was the first disease treated with CAR-T and with a T-cell engager.
Acute lymphoblastic leukaemia is the commonest childhood cancer and a rarer, harder disease in adults. B-cell precursor ALL (85%) is classified by genetics into favourable (ETV6::RUNX1, high hyperdiploidy), intermediate, and adverse groups (KMT2A rearrangement, hypodiploidy, Ph-like/CRLF2, iAMP21, TCF3::HLF); Ph-positive (BCR::ABL1) disease accounts for a quarter of adult cases. T-ALL (15%) has its own genetics and, since 2023, its own targeted options (nelarabine, BCL-2 inhibition in trials). Measurable residual disease after induction is the strongest predictor of relapse in every subgroup.
Children are cured in over 90% with risk-adapted multi-agent chemotherapy over two to three years, and since 2024 with blinatumomab woven into consolidation (AALL1731: 3-year DFS 96% vs 88%). Adults do worse with chemotherapy alone, but three immunotherapies changed the picture: blinatumomab (E1910: 3-year OS 85% vs 68% when added frontline; standard in MRD-positive and relapsed disease), the CD22 ADC inotuzumab ozogamicin (INO-VATE: 81% remission in relapse), and CD19 CAR-T (tisagenlecleucel for patients up to 25; obe-cel for adults, 2024). Ph-positive ALL is treated with a BCR::ABL1 inhibitor (ponatinib preferred since PhALLCON, 2024) and increasingly with TKI plus blinatumomab and no chemotherapy at all (D-ALBA), while KMT2A-rearranged disease now has menin inhibitors.
Allogeneic transplant remains standard for high-risk or MRD-persistent disease but is being pushed back by MRD-negative remissions achieved with immunotherapy. The unsolved problems are CD19-negative relapse after CAR-T and blinatumomab, T-ALL relapse, Ph-like ALL, infant KMT2A-rearranged ALL, the late toxicities of paediatric therapy, and the very different outcomes for adolescents and adults treated outside specialised centres.
State of the art today
- Immunotherapy in frontline paediatric therapy.
- Two CD19 CAR-T products for ALL (tisagenlecleucel, obe-cel) with obe-cel showing markedly lower severe CRS and neurotoxicity; REMS removed for CAR-T in 2025.
- Inotuzumab ozogamicin gives ~80% remission in relapse and is moving into frontline lower-intensity regimens for older adults and children.
- MRD at 10^-5 to 10^-6 (clonoSEQ, PCR) is the organising principle for transplant, blinatumomab, and de-escalation decisions.
- Menin inhibitors reach KMT2A-rearranged ALL, the first targeted therapy for infant leukaemia.
Show survival figures (2)
Averages across everyone diagnosed, often years ago. Your stage, subtype, age, fitness and the treatment you receive matter more than the average, and the numbers are improving quickly.
- Blinatumomab in frontline consolidation improves survival in adults (E1910) and children (AALL1731) regardless of MRD; approved June 2024.
- Ph-positive ALL: ponatinib is the preferred TKI (PhALLCON) and chemotherapy-free TKI + blinatumomab regimens achieve 18-month survival near 95%.
Show survival figures (1)
Averages across everyone diagnosed, often years ago. Your stage, subtype, age, fitness and the treatment you receive matter more than the average, and the numbers are improving quickly.
- About 6,500 US cases a year, 60% in children; 5-year survival above 90% in children and about 40-50% in adults, better in those under 40 treated on paediatric-style regimens.
Where the cases are
Site: Leukaemia (all types) (shared total; subtype split not reported). World: 487,294 new cases, 305,405 deaths.
| # | Country | New cases | Deaths | Incidence ASR |
|---|---|---|---|---|
| 1 | China | 81,946 | 50,074 | |
| 2 | United States of America | 63,144 | 23,460 | |
| 3 | India | 49,883 | 36,871 | |
| 4 | Germany | 15,108 | 9,378 | |
| 5 | Russian Federation | 14,495 | 8,224 | |
| 6 | Indonesia | 13,959 | 10,370 | |
| 7 | Japan | 13,572 | 10,066 | |
| 8 | France (metropolitan) | 13,525 | 7,387 | |
| 9 | Brazil | 11,859 | 8,790 | |
| 10 | Italy | 10,799 | 7,197 |
GLOBOCAN reports leukaemia as one site; ALL is the commonest childhood cancer but a minority of adult leukaemia.
Risk-adapted chemotherapy + blinatumomab consolidation; TKI if Ph+.
CAR-T (tisagenlecleucel, obe-cel), inotuzumab, transplant.
Risk-adapted multi-agent chemotherapy (induction, consolidation, interim maintenance, delayed intensification, 2-3 years maintenance) with two cycles of blinatumomab in consolidation (AALL1731, approved June 2024); intrathecal CNS prophylaxis; cranial radiation abandoned for most.
Intensified chemotherapy; blinatumomab for MRD persistence (AALL1331 in relapse); inotuzumab and CAR-T (tisagenlecleucel) for relapse; allogeneic transplant for very high risk or MRD persistence.
Interfant-21 backbone with blinatumomab; transplant for high-risk; menin inhibitors in trials.
Paediatric-inspired regimens (CALGB 10403, GRAALL, UKALL) with asparaginase; blinatumomab consolidation (E1910); MRD-guided transplant.
Hyper-CVAD or age-adapted multi-agent chemotherapy with blinatumomab interleaved in consolidation (E1910); inotuzumab-containing lower-intensity regimens (Mini-hyper-CVD + InO ± blinatumomab) for older adults; MRD-driven transplant.
Ponatinib (PhALLCON) or dasatinib with reduced-intensity chemotherapy, or chemotherapy-free TKI + blinatumomab (D-ALBA); BCR::ABL1 PCR monitoring; transplant for MRD persistence or IKZF1-plus, increasingly omitted for MRD-negative patients.
Blinatumomab (BLAST; full approval 2018) to convert to MRD negativity, then transplant or continued blinatumomab-based therapy.
Blinatumomab (TOWER) or inotuzumab (INO-VATE) as salvage and bridge; CD19 CAR-T (tisagenlecleucel ≤25 years; obe-cel or brexucabtagene in adults) for second salvage or as definitive therapy; transplant for those not previously transplanted; CD22 or dual CAR-T for CD19-negative relapse in trials.
Intensive paediatric-type chemotherapy with nelarabine for high-risk (AALL0434); relapse: nelarabine, venetoclax combinations, CD7 CAR-T and daratumumab in trials; transplant in CR2.
Subtypes & biomarkers
top- B-cell precursor ALL (85%): ETV6::RUNX1, high hyperdiploidy (favourable); Ph-positive BCR::ABL1 (25% of adults); Ph-like/CRLF2 (adverse, targetable in trials); KMT2A-rearranged (infants); hypodiploid, iAMP21, TCF3::HLF, DUX4/ZNF384 fusions
- T-cell ALL (15%): early T-precursor (ETP) subtype adverse; NOTCH1 mutated majority
- Mixed-phenotype acute leukaemia
- Burkitt-type (mature B) leukaemia, treated as lymphoma
- BCR-ABL (Ph+)
- KMT2A
- Ph-like signature
- MRD (flow/NGS)
- MRD by flow (10^-4) or clonoSEQ/PCR (10^-5 to 10^-6) at end of induction and consolidation
- BCR ::ABL1 (Ph+) and transcript type
- KMT2A rearrangement (menin inhibitor eligibility; infants)
- Ph-like signature (CRLF2, ABL-class fusions, JAK mutations)
- IKZF1 deletion / IKZF1-plus (adverse, especially in Ph+)
- Hypodiploidy (<44 chromosomes) and TP53 germline testing
- CD19 and CD22 expression and density (immunotherapy targets and escape)
- CNS involvement at diagnosis
- Age and white count (NCI risk in children)
Target prevalence in this cancer
| Target / alteration | Prevalence | Measure | Source |
|---|---|---|---|
| CD19 | >95% | B-ALL surface expression | Wikipedia |
| CD22 | >90% | expression on B-ALL blasts | |
| Menin | 5-10% | KMT2A rearrangement (adult); ~70% infant ALL | Wikipedia |
| BCR::ABL1 (Philadelphia chromosome) | ~25 adults; ~3 children% | t(9;22) | |
| KMT2A (MLL) rearrangement | ~80 in infants; 5-10 in adults% | rearrangement |
How common each drug target or alteration is in this cancer. Population-level and approximate; see the target page for detail. Full matrix.
- 1948Farber: aminopterin remissions, birth of chemotherapy
- 1948Farber induces the first leukaemia remissions
Aminopterin in children with ALL; the birth of cancer chemotherapy.
- 1962Combination chemotherapy and CNS prophylaxis
Pinkel's 'total therapy' at St. Jude: multi-agent induction, cranial irradiation, maintenance; first cures.
- 1990Risk-adapted therapy standardised
NCI/Rome criteria (age, white count); paediatric cooperative groups reach ~70% cure.
- 2000Imatinib transforms Ph-positive leukaemia
First BCR::ABL1 inhibitor; Ph+ ALL survival doubles when added to chemotherapy.
- 2009MRD becomes the key risk factor
AIEOP-BFM 2000 and UKALL 2003 show end-of-induction MRD outperforms every clinical factor; MRD-directed therapy adopted.
- 2012First CAR-T cures: Emily Whitehead
CTL019 at CHOP/Penn; durable remission of refractory paediatric ALL.
- 2014Blinatumomab: first BiTE
- 2014Blinatumomab: first bispecific T-cell engager approved
Accelerated approval in relapsed/refractory Ph-negative B-ALL.
- 2016INO-VATE: CD22 ADC beats chemotherapy in relapse
CR/CRi 81% vs 29%; approval 2017.
- 2017Tisagenlecleucel: first CAR-T
- 2017Kymriah: first CAR-T approved; TOWER confirms blinatumomab OS benefit
ELIANA-based approval for ALL up to age 25; TOWER OS 7.7 vs 4.0 months.
- 2018Blinatumomab approved for MRD-positive ALL
First approval based on an MRD endpoint (BLAST).
- 2020D-ALBA: chemotherapy-free Ph+ ALL
Dasatinib then blinatumomab, 18-month OS 95%.
- 2024Blinatumomab frontline
- 2024Blinatumomab frontline (E1910, AALL1731), ponatinib frontline (PhALLCON), obe-cel approved
Immunotherapy becomes part of standard first-line therapy for adults and children; second CAR-T for adult ALL; revumenib approved for KMT2Ar leukaemia.
- 2025REMS removed for CAR-T; menin inhibitor combinations enter ALL trials
FDA lifts REMS for approved CAR-T products; ziftomenib and revumenib studied in KMT2Ar ALL.
- 2026Subcutaneous blinatumomab and Interfant-21 progress
Subcutaneous blinatumomab trials (including the first in mixed-phenotype leukaemia) aim to replace continuous infusion; infant trials integrate blinatumomab.
Open problems
- Adult ALL outcomes.
- CD19-negative relapse.
- CD19-negative relapse after blinatumomab or CAR-T; CD22 and dual-antigen CARs are early.
- T-cell ALL has no approved immunotherapy; CD7 CAR-T (fratricide) and venetoclax combinations are experimental.
- Ph-like ALL (CRLF2, JAK) has poor outcomes and only trial access to JAK/ABL-class inhibitors.
- Infant KMT2A-rearranged ALL still has EFS under 50% on chemotherapy alone.
- Continuous-infusion blinatumomab is burdensome; subcutaneous formulation not yet approved.
- Which adults can safely skip transplant after MRD-negative immunotherapy remission is untested in randomised trials.
- Late effects of curative paediatric therapy (neurocognitive, cardiac, second cancers) and survivorship care.
- Adults treated outside academic centres have markedly worse survival; access to CAR-T and paediatric-inspired protocols is uneven.
Trials
topRecruiting now (live from ClinicalTrials.gov)
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Landmark trials in OnCo
Expert centres
topCentres linked to this cancer in OnCo
- via CAR-T cell therapy
- via CAR-T cell therapy
- GIMEMARome, ITvia this cancer, Blinatumomab, D-ALBA (GIMEMA LAL2116), Imatinib
- Children's Hospital of PhiladelphiaPhiladelphia, PA, USvia this cancer, CAR-T cell therapy, Tisagenlecleucel
- Children's Oncology Group (COG)Monrovia, CA, USvia this cancer, Blinatumomab, COG AALL1731
- ECOG-ACRIN Cancer Research GroupPhiladelphia, PA, USvia this cancer, Blinatumomab, ECOG-ACRIN E1910
- Seoul St. Mary's HospitalSeoul, KRvia this cancer, CAR-T cell therapy, Imatinib
- via this cancer, CAR-T cell therapy
- All India Institute of Medical Sciences, New DelhiNew Delhi, INvia this cancer, CAR-T cell therapy
- American Society of HematologyWashington, DC, USvia this cancer, CAR-T cell therapy
- Central Drugs Standard Control OrganizationNew Delhi, INvia CAR-T cell therapy, Imatinib
- Christian Medical College, VelloreVellore, INvia this cancer, CAR-T cell therapy
- European Hematology AssociationThe Hague, NLvia this cancer, CAR-T cell therapy
- via this cancer, CAR-T cell therapy
- Hadassah Medical CenterJerusalem, ILvia this cancer, CAR-T cell therapy
- Hospital Clínic de Barcelona / IDIBAPSBarcelona, ESvia this cancer, CAR-T cell therapy
- HOVONRotterdam, NLvia this cancer, Venetoclax
- IRCCS Ospedale San RaffaeleMilan, ITvia this cancer, CAR-T cell therapy
- Juravinski Cancer Centre / Escarpment Cancer Research InstituteHamilton, ON, CAvia Allogeneic stem cell transplantation, CAR-T cell therapy
- via this cancer, CAR-T cell therapy
- via this cancer, Allogeneic stem cell transplantation
- via Imatinib, BCR::ABL1 (Philadelphia chromosome)
- via this cancer, CAR-T cell therapy
- Ruijin Hospital, Shanghai Jiao Tong UniversityShanghai, CNvia this cancer, CAR-T cell therapy
- via this cancer, Interfant-06
- via this cancer, CAR-T cell therapy
- Texas Children's Cancer and Hematology CenterHouston, TX, USvia this cancer, CAR-T cell therapy
- University Cancer Center Frankfurt (UCT)Frankfurt am Main, DEvia this cancer, CAR-T cell therapy
- via this cancer, CAR-T cell therapy
- via this cancer, CAR-T cell therapy
- via CAR-T cell therapy
- Advanced Research Projects Agency for HealthWashington, DC, USvia CAR-T cell therapy
- via CAR-T cell therapy
- via CAR-T cell therapy
- Cancer Institute (WIA), AdyarChennai, INvia this cancer
- Chan Zuckerberg BiohubSan Francisco, USvia CAR-T cell therapy
- Children's Cancer and Leukaemia GroupLeicester, GBvia this cancer
- via this cancer
- Chinese PLA General HospitalBeijing, CNvia CAR-T cell therapy
- via CAR-T cell therapy
- City of Hope Orange CountyIrvine, CA, USvia CAR-T cell therapy
- Cleveland Clinic Abu DhabiAbu Dhabi, AEvia CAR-T cell therapy
- via CAR-T cell therapy
- via CAR-T cell therapy
- Dan L Duncan Comprehensive Cancer Center, Baylor College of MedicineHouston, TX, USNCI comprehensivevia CAR-T cell therapy
- European Medicines AgencyAmsterdam, NLvia CAR-T cell therapy
- via BCR::ABL1 (Philadelphia chromosome)
- via Allogeneic stem cell transplantation
- via CAR-T cell therapy
- Geneva University Hospitals (HUG)Geneva, CHvia CAR-T cell therapy
- Groote Schuur Hospital / University of Cape TownCape Town, ZAvia this cancer
- Henan Cancer HospitalZhengzhou, CNvia CAR-T cell therapy
- via this cancer
- Hospital de Clínicas de Porto AlegrePorto Alegre, BRvia this cancer
- via CAR-T cell therapy
- Hospital Universitari i Politècnic La FeValencia, ESvia this cancer
- Hospital Universitario 12 de OctubreMadrid, ESvia CAR-T cell therapy
- via CAR-T cell therapy
- Indiana University Melvin and Bren Simon Comprehensive Cancer CenterIndianapolis, IN, USNCI comprehensivevia Allogeneic stem cell transplantation
- via CAR-T cell therapy
- Institut Paoli-CalmettesMarseille, FRvia CAR-T cell therapy
- Instituto Nacional de Câncer (INCA)Rio de Janeiro, BRvia this cancer
- via this cancer
- via this cancer
- via this cancer
- via CAR-T cell therapy
- via CAR-T cell therapy
- via CAR-T cell therapy
- Kidwai Memorial Institute of OncologyBengaluru, INvia this cancer
- King Hussein Cancer CenterAmman, JOvia this cancer
- LYSA – The Lymphoma Study AssociationPierre-Bénite (Lyon), FRvia CAR-T cell therapy
- via CAR-T cell therapy
- via CAR-T cell therapy
- National Cancer Centre SingaporeSingapore, SGvia CAR-T cell therapy
- via this cancer
- via CAR-T cell therapy
- via CAR-T cell therapy
- Nationwide Children's HospitalColumbus, OH, USvia CAR-T cell therapy
- NCI Center for Cancer Research (intramural programme)Bethesda, MD, USvia CAR-T cell therapy
- Newcastle Cancer Centre / Northern Centre for Cancer CareNewcastle upon Tyne, GBvia this cancer
- Northwell Health Cancer InstituteNew Hyde Park, NY, USvia CAR-T cell therapy
- Peking University Cancer HospitalBeijing, CNvia CAR-T cell therapy
- Philippine General HospitalManila, PHvia this cancer
- via this cancer
- Ramathibodi Hospital, Mahidol UniversityBangkok, THvia this cancer
- Rigshospitalet – Copenhagen University HospitalCopenhagen, DKvia CAR-T cell therapy
- via CAR-T cell therapy
- Sheba Medical CenterRamat Gan, ILvia CAR-T cell therapy
- via CAR-T cell therapy
- Siriraj Hospital, Mahidol UniversityBangkok, THvia CAR-T cell therapy
- Society for Immunotherapy of CancerMilwaukee, WI, USvia CAR-T cell therapy
- via this cancer
- Taipei Veterans General HospitalTaipei, TWvia CAR-T cell therapy
- Tata Medical Center, KolkataKolkata, INvia this cancer
- Tawam HospitalAl Ain, AEvia this cancer
- The Hospital for Sick Children (SickKids)Toronto, ON, CAvia this cancer
- via CAR-T cell therapy
- via CAR-T cell therapy
- via CAR-T cell therapy
- via CAR-T cell therapy
- via CAR-T cell therapy
- via CAR-T cell therapy
- University Hospital Düsseldorf / CIO DüsseldorfDüsseldorf, DEvia this cancer
- via BCR::ABL1 (Philadelphia chromosome)
- University of Maryland Marlene and Stewart Greenebaum Comprehensive Cancer CenterBaltimore, MD, USNCI comprehensivevia Allogeneic stem cell transplantation
- via this cancer
- Walter and Eliza Hall Institute of Medical ResearchMelbourne, AUvia Venetoclax
- via this cancer
Questions to ask
topQuestions to ask your oncologist about Acute lymphoblastic leukaemia
Newly diagnosed
- What is my exact diagnosis, stage, and grade, and which tests established them?Why: Everything else follows from an accurate stage and subtype.
- Which biomarkers have been tested on my tumour (for example BCR-ABL, KMT2A, Ph-like signature, MRD, MRD by flowor clonoSEQ/PCRat end of induction and consolidation), and what were the results?Why: These results decide eligibility for targeted therapy, immunotherapy, and trials.
- Which subtype is my cancer, and does that change the recommended treatment?Why: Recognised subtypes for this cancer include B-cell precursor ALL: ETV6::RUNX1, high hyperdiploidy; Ph-positive BCR::ABL1; Ph-like/CRLF2; KMT2A-rearranged; hypodiploid, iAMP21, TCF3::HLF, DUX4/ZNF384 fusions, T-cell ALL: early T-precursorsubtype adverse; NOTCH1 mutated majority, Mixed-phenotype acute leukaemia.
- Is germline (inherited) genetic testing recommended for me or my family?Why: Inherited variants can change treatment and matter for relatives.
Frontline
- For my situation (frontline), which of the standard options do you recommend and why?Why: Guideline options include: Risk-adapted chemotherapy + blinatumomab consolidation; TKI if Ph+.
- Am I a candidate for Blinatumomab, and what side effects should I expect?Why: Knowing the expected toxicities helps you plan work, family, and supportive care.
Relapsed
- For my situation (relapsed), which of the standard options do you recommend and why?Why: Guideline options include: CAR-T (tisagenlecleucel, obe-cel), inotuzumab, transplant.
- Am I a candidate for Revumenib, and what side effects should I expect?Why: Knowing the expected toxicities helps you plan work, family, and supportive care.
Children, standard risk B-ALL
- For my situation (children, standard risk b-all), which of the standard options do you recommend and why?Why: Guideline options include: Risk-adapted multi-agent chemotherapy (induction, consolidation, interim maintenance, delayed intensification, 2-3 years maintenance) with two cycles of blinatumomab in consolidation (AALL1731, approved June 2024); intrathecal CNS prophylaxis; cranial radiation abandoned for most.
- Am I a candidate for Blinatumomab, and what side effects should I expect?Why: Knowing the expected toxicities helps you plan work, family, and supportive care.
- How do the results of COG AALL1731 apply to someone like me?Why: Trial populations differ from individual patients; ask how closely you match.
Children, high risk or MRD-positive
- For my situation (children, high risk or mrd-positive), which of the standard options do you recommend and why?Why: Guideline options include: Intensified chemotherapy; blinatumomab for MRD persistence (AALL1331 in relapse); inotuzumab and CAR-T (tisagenlecleucel) for relapse; allogeneic transplant for very high risk or MRD persistence.
- Am I a candidate for Blinatumomab, Inotuzumab ozogamicin, Tisagenlecleucel, and what side effects should I expect?Why: Knowing the expected toxicities helps you plan work, family, and supportive care.
Infants (<1 year), KMT2A-rearranged
- For my situation (infants (<1 year), kmt2a-rearranged), which of the standard options do you recommend and why?Why: Guideline options include: Interfant-21 backbone with blinatumomab; transplant for high-risk; menin inhibitors in trials.
- Am I a candidate for Blinatumomab, and what side effects should I expect?Why: Knowing the expected toxicities helps you plan work, family, and supportive care.
- How do the results of Interfant-06 apply to someone like me?Why: Trial populations differ from individual patients; ask how closely you match.
Adolescents and young adults (15-39), Ph-negative
- For my situation (adolescents and young adults (15-39), ph-negative), which of the standard options do you recommend and why?Why: Guideline options include: Paediatric-inspired regimens (CALGB 10403, GRAALL, UKALL) with asparaginase; blinatumomab consolidation (E1910); MRD-guided transplant.
- Am I a candidate for Blinatumomab, and what side effects should I expect?Why: Knowing the expected toxicities helps you plan work, family, and supportive care.
- How do the results of ECOG-ACRIN E1910 apply to someone like me?Why: Trial populations differ from individual patients; ask how closely you match.
Adults 40-70, Ph-negative
- For my situation (adults 40-70, ph-negative), which of the standard options do you recommend and why?Why: Guideline options include: Hyper-CVAD or age-adapted multi-agent chemotherapy with blinatumomab interleaved in consolidation (E1910); inotuzumab-containing lower-intensity regimens (Mini-hyper-CVD + InO ± blinatumomab) for older adults; MRD-driven transplant.
- Am I a candidate for Blinatumomab, Inotuzumab ozogamicin, and what side effects should I expect?Why: Knowing the expected toxicities helps you plan work, family, and supportive care.
- How do the results of ECOG-ACRIN E1910 apply to someone like me?Why: Trial populations differ from individual patients; ask how closely you match.
Ph-positive ALL, newly diagnosed
- For my situation (ph-positive all, newly diagnosed), which of the standard options do you recommend and why?Why: Guideline options include: Ponatinib (PhALLCON) or dasatinib with reduced-intensity chemotherapy, or chemotherapy-free TKI + blinatumomab (D-ALBA); BCR::ABL1 PCR monitoring; transplant for MRD persistence or IKZF1-plus, increasingly omitted for MRD-negative patients.
- Am I a candidate for Ponatinib, Dasatinib, Blinatumomab, and what side effects should I expect?Why: Knowing the expected toxicities helps you plan work, family, and supportive care.
- How do the results of PhALLCON and D-ALBA (GIMEMA LAL2116) apply to someone like me?Why: Trial populations differ from individual patients; ask how closely you match.
MRD-positive after induction or consolidation
- For my situation (mrd-positive after induction or consolidation), which of the standard options do you recommend and why?Why: Guideline options include: Blinatumomab (BLAST; full approval 2018) to convert to MRD negativity, then transplant or continued blinatumomab-based therapy.
- Am I a candidate for Blinatumomab, and what side effects should I expect?Why: Knowing the expected toxicities helps you plan work, family, and supportive care.
Relapsed or refractory B-ALL
- For my situation (relapsed or refractory b-all), which of the standard options do you recommend and why?Why: Guideline options include: Blinatumomab (TOWER) or inotuzumab (INO-VATE) as salvage and bridge; CD19 CAR-T (tisagenlecleucel ≤25 years; obe-cel or brexucabtagene in adults) for second salvage or as definitive therapy; transplant for those not previously transplanted; CD22 or dual CAR-T for CD19-negative relapse in trials.
- Am I a candidate for Blinatumomab, Inotuzumab ozogamicin, Tisagenlecleucel or related drugs, and what side effects should I expect?Why: Knowing the expected toxicities helps you plan work, family, and supportive care.
- How do the results of TOWER and INO-VATE ALL apply to someone like me?Why: Trial populations differ from individual patients; ask how closely you match.
T-cell ALL
- For my situation (t-cell all), which of the standard options do you recommend and why?Why: Guideline options include: Intensive paediatric-type chemotherapy with nelarabine for high-risk (AALL0434); relapse: nelarabine, venetoclax combinations, CD7 CAR-T and daratumumab in trials; transplant in CR2.
- Am I a candidate for Venetoclax, and what side effects should I expect?Why: Knowing the expected toxicities helps you plan work, family, and supportive care.
Any stage
- Are there clinical trials I could join, for example of Revumenib, Obecabtagene autoleucel, Ponatinib, Asciminib?Why: Trials are how the next standard of care is set; asking early keeps options open.
- Would a second opinion at a high-volume centre change anything, and can you help arrange it?Why: Rare or high-stakes decisions benefit from a centre that treats many similar patients.
- What supportive care (symptom control, nutrition, exercise, mental health, financial help) is available from the start?Why: Supportive care improves quality of life and helps patients complete treatment.
- I read that “Adult ALL outcomes”. How does that affect my plan?Why: Open problems are where trials and second opinions matter most.
- I read that “CD19-negative relapse”. How does that affect my plan?Why: Open problems are where trials and second opinions matter most.
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Direct links plus the targets, companies, and technologies of this cancer's products.
technologies
15targets
11drugs
18companies
16institutions
50pathways
1terms
8trials
10pairings
3ideas
20collections
3people
21bottlenecks
5key papers
7AALL1731 brings immunotherapy into the front-line treatment of the commonest childhood cancer, in the group of children where most relapses were occurring despite good initial risk. Blinatumomab was approved for this use in 2024 and paediatric protocols worldwide are being amended. Whether it can allow less chemotherapy, and its effect on very low-risk children, are the next questions.
E1910 changed the standard of care for adult B-ALL: immunotherapy is now part of front-line consolidation even for patients with no detectable leukaemia, because MRD-negative by flow cytometry does not mean cured. It also demonstrated that a T-cell engager can improve overall survival in a curative setting. Chemotherapy-light or chemotherapy-free regimens built on blinatumomab and inotuzumab are the next step.
Revumenib proved that a transcriptional dependency, rather than a kinase, can be drugged in leukaemia, opening treatment for two genetic subgroups that together cover roughly a third of AML plus most infant ALL. It is now approved and is being combined with venetoclax-azacitidine and intensive chemotherapy in front-line trials. Single-agent remissions are often short without transplant.
The UCART19 report was the first clinical evidence that a universal, pre-manufactured CAR-T made from a donor can work, avoiding the weeks of autologous manufacturing and the problem of patients whose own T cells are too damaged. It set the template for later allogeneic programmes (including cemacabtagene autoleucel in the ALPHA studies) and for in vivo CAR generation. Short persistence and the need for deep lymphodepletion remain the central weaknesses.
ELIANA turned CAR-T from a single-centre experiment into a licensed product and created the regulatory and logistical template every later cell therapy has followed. For children with refractory leukaemia it offers a chance of durable remission without transplant. The trial also exposed the gaps: manufacturing failures, patients dying while waiting, and roughly half relapsing within a few years.
INO-VATE made inotuzumab a standard salvage therapy for adult ALL and a common route to transplant, and, with the TOWER trial of blinatumomab, moved adult ALL from chemotherapy-only salvage to immunotherapy. Both drugs have since been pulled into front-line regimens. The liver toxicity signal shaped how transplant conditioning is chosen after inotuzumab.
This paper is the proof-of-concept for a living drug: a single infusion of a patient's own engineered T cells could eradicate leukaemia that had survived chemotherapy, transplant and antibody therapy. It defined cytokine release syndrome and its antidote, tocilizumab, and revealed antigen-loss relapse. It led directly to the first approved gene-modified cell therapy three years later.
Latest papers
topQuery for this cancer: (TITLE:"Acute lymphoblastic leukaemia" OR ABSTRACT:"Acute lymphoblastic leukaemia") AND (treatment OR therapy OR trial OR survival OR diagnosis). Results are unfiltered search hits about Acute lymphoblastic leukaemia, not a curated reading list.