Acute lymphoblastic leukaemia: the decisions you may face

No trial record is attached to this row yet. The trials tab lists what is recruiting and the landmark trials for this cancer.

1. Is Blinatumomab the only reasonable path for me, or is there a trial, a different sequence or a wait-and-see option?
   Why: A single standard does not mean a single choice; timing and trials are decisions too.
2. What is each option trying to achieve: cure, long control, or relief of symptoms, and over what time?
   Why: The aim shapes how much side effect and disruption is worth accepting.
3. Which side effects of Blinatumomab are most likely for me, which are reversible, and which would make us stop?
   Why: The recorded rates below come from labels and trials; your own risk depends on dose, other medicines and your health.
4. What happens if I delay, or decline this step for now? Is the decision reversible?
   Why: Some decisions can wait for a second opinion or a trial slot; others cannot. Knowing which is part of the choice.
5. Does your recommendation follow the current guideline (NCCN Guidelines: Acute Lymphoblastic Leukemia), and if it departs from it, why?
   Why: Departures from guidelines are sometimes right for an individual; they should be explained.
6. 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+.
7. 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.

Add these to your appointment list, or take the full question set for this cancer.

No trial record is attached to this row yet. The trials tab lists what is recruiting and the landmark trials for this cancer.

1. Between CAR-T cell therapy and Revumenib, which do you recommend for me, and what about my case would make you choose differently?
   Why: Guidelines list several reasonable options; the choice turns on details of your tumour, your health and your priorities.
2. What is each option trying to achieve: cure, long control, or relief of symptoms, and over what time?
   Why: The aim shapes how much side effect and disruption is worth accepting.
3. What happens if I delay, or decline this step for now? Is the decision reversible?
   Why: Some decisions can wait for a second opinion or a trial slot; others cannot. Knowing which is part of the choice.
4. Does your recommendation follow the current guideline (NCCN Guidelines: Acute Lymphoblastic Leukemia), and if it departs from it, why?
   Why: Departures from guidelines are sometimes right for an individual; they should be explained.
5. 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.
6. 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.

Add these to your appointment list, or take the full question set for this cancer.

• COG AALL1731Phase 3NCT0391462520241,440 peopleevidence 90
  Tests Blinatumomab
  Newly diagnosed standard-risk B-ALL in children: two cycles of blinatumomab added to chemotherapy vs chemotherapy alone
  ▸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.

  • 3-year DFS 96.0% vs 87.9%; HR 0.39.
  Disease-free survival at 3 years (%): Blinatumomab + chemotherapy 96 (n=722) vs Chemotherapy 87.9 (n=718) · HR 0.39 · source

1. Between Blinatumomab and Multiparameter flow cytometry MRD, which do you recommend for me, and what about my case would make you choose differently?
   Why: Guidelines list several reasonable options; the choice turns on details of your tumour, your health and your priorities.
2. What is each option trying to achieve: cure, long control, or relief of symptoms, and over what time?
   Why: The aim shapes how much side effect and disruption is worth accepting.
3. How closely do I match the people in COG AALL1731, and does that change what the results mean for me?
   Why: Trial populations are selected; age, fitness, prior treatment and biomarkers all affect how far results carry.
4. Which side effects of Blinatumomab are most likely for me, which are reversible, and which would make us stop?
   Why: The recorded rates below come from labels and trials; your own risk depends on dose, other medicines and your health.
5. What happens if I delay, or decline this step for now? Is the decision reversible?
   Why: Some decisions can wait for a second opinion or a trial slot; others cannot. Knowing which is part of the choice.
6. Does your recommendation follow the current guideline (NCCN Pediatric ALL 2026), and if it departs from it, why?
   Why: Departures from guidelines are sometimes right for an individual; they should be explained.
7. 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.
8. 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.
9. How do the results of COG AALL1731 apply to someone like me?
   Why: Trial populations differ from individual patients; ask how closely you match.

Add these to your appointment list, or take the full question set for this cancer.

• AALL1331Phase 3NCT021018532021669 peopleevidence 69
  Tests Blinatumomab
  Children, adolescents and young adults aged 1 to 30 with a first relapse of B-cell acute lymphoblastic leukaemia: after one block of reinduction chemotherapy, blinatumomab in place of intensive consolidation chemotherapy (high and intermediate risk, then transplant) or intercalated with chemotherapy (low risk)

  Blinatumomab consolidation gave two-year disease-free survival of 54.4 percent against 39.0 percent with chemotherapy in high- and intermediate-risk relapse (not statistically significant after early closure), with better overall survival and far less toxicity; in low-risk bone marrow relapse it improved disease-free and overall survival.

  Disease-free survival at 2 years, high- and intermediate-risk relapse (%): Blinatumomab consolidation then transplant 54.4 (n=105) vs Chemotherapy consolidation then transplant 39 (n=103) · HR 0.7 · source

1. Between Blinatumomab, Inotuzumab ozogamicin, Tisagenlecleucel and the other options, which do you recommend for me, and what about my case would make you choose differently?
   Why: Guidelines list several reasonable options; the choice turns on details of your tumour, your health and your priorities.
2. What is each option trying to achieve: cure, long control, or relief of symptoms, and over what time?
   Why: The aim shapes how much side effect and disruption is worth accepting.
3. How closely do I match the people in AALL1331, and does that change what the results mean for me?
   Why: Trial populations are selected; age, fitness, prior treatment and biomarkers all affect how far results carry.
4. Which side effects of Blinatumomab or Inotuzumab ozogamicin are most likely for me, which are reversible, and which would make us stop?
   Why: The recorded rates below come from labels and trials; your own risk depends on dose, other medicines and your health.
5. What happens if I delay, or decline this step for now? Is the decision reversible?
   Why: Some decisions can wait for a second opinion or a trial slot; others cannot. Knowing which is part of the choice.
6. Does your recommendation follow the current guideline (NCCN Pediatric ALL 2026), and if it departs from it, why?
   Why: Departures from guidelines are sometimes right for an individual; they should be explained.
7. 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.
8. 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.
9. How do the results of AALL1331 apply to someone like me?
   Why: Trial populations differ from individual patients; ask how closely you match.

Add these to your appointment list, or take the full question set for this cancer.

• Interfant-06Phase 3NCT005509922019651 peopleevidence 79
  Tests Blinatumomab
  Infant ALL (<1 year): standard vs AML-type early intensification; transplant for high-risk KMT2A-rearranged infants
  ▸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.

  • 6-year EFS 46.1%; intensification no benefit.
  Event-free survival at 6 years (%): All infants 46.1 (n=651) · source

1. Is Blinatumomab the only reasonable path for me, or is there a trial, a different sequence or a wait-and-see option?
   Why: A single standard does not mean a single choice; timing and trials are decisions too.
2. What is each option trying to achieve: cure, long control, or relief of symptoms, and over what time?
   Why: The aim shapes how much side effect and disruption is worth accepting.
3. How closely do I match the people in Interfant-06, and does that change what the results mean for me?
   Why: Trial populations are selected; age, fitness, prior treatment and biomarkers all affect how far results carry.
4. Which side effects of Blinatumomab are most likely for me, which are reversible, and which would make us stop?
   Why: The recorded rates below come from labels and trials; your own risk depends on dose, other medicines and your health.
5. What happens if I delay, or decline this step for now? Is the decision reversible?
   Why: Some decisions can wait for a second opinion or a trial slot; others cannot. Knowing which is part of the choice.
6. Does your recommendation follow the current guideline (NCCN Pediatric ALL 2026), and if it departs from it, why?
   Why: Departures from guidelines are sometimes right for an individual; they should be explained.
7. 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.
8. 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.
9. How do the results of Interfant-06 apply to someone like me?
   Why: Trial populations differ from individual patients; ask how closely you match.

Add these to your appointment list, or take the full question set for this cancer.

• ECOG-ACRIN E1910Phase 3NCT020032222024488 peopleevidence 93
  Tests Blinatumomab
  Newly diagnosed Ph-negative B-ALL, age 30-70, in MRD-negative remission after induction: blinatumomab added to consolidation chemotherapy vs chemotherapy alone
  ▸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.

  • 3-year OS 85% vs 68%; HR 0.41.
  Overall survival at 3 years (MRD-negative cohort) (%): Blinatumomab + chemotherapy 85 (n=112) vs Chemotherapy 68 (n=112) · HR 0.41 · source
• GRAALL-2005Phase 3NCT0032767820181,080 peopleevidence 64
  Adults aged 18 to 59 with newly diagnosed Philadelphia-negative acute lymphoblastic leukaemia treated with a paediatric-inspired protocol: standard-dose or hyperfractionated cyclophosphamide during induction and late intensification

  Hyperfractionated cyclophosphamide did not improve remission, event-free or overall survival; five-year event-free survival was 52.2 percent overall and 55.7 percent under age 55 against 25.8 percent at 55 and over.

  Event-free survival at 5 years (%): All evaluable patients on the paediatric-inspired protocol 52.2 (n=787) · source

1. Between Blinatumomab and NGS-based MRD (clonoSEQ and molecular MRD), which do you recommend for me, and what about my case would make you choose differently?
   Why: Guidelines list several reasonable options; the choice turns on details of your tumour, your health and your priorities.
2. What is each option trying to achieve: cure, long control, or relief of symptoms, and over what time?
   Why: The aim shapes how much side effect and disruption is worth accepting.
3. How closely do I match the people in ECOG-ACRIN E1910 and GRAALL-2005, and does that change what the results mean for me?
   Why: Trial populations are selected; age, fitness, prior treatment and biomarkers all affect how far results carry.
4. Which side effects of Blinatumomab are most likely for me, which are reversible, and which would make us stop?
   Why: The recorded rates below come from labels and trials; your own risk depends on dose, other medicines and your health.
5. What happens if I delay, or decline this step for now? Is the decision reversible?
   Why: Some decisions can wait for a second opinion or a trial slot; others cannot. Knowing which is part of the choice.
6. Does your recommendation follow the current guideline (NCCN ALL 2026), and if it departs from it, why?
   Why: Departures from guidelines are sometimes right for an individual; they should be explained.
7. 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.
8. 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.
9. How do the results of ECOG-ACRIN E1910 and GRAALL-2005 apply to someone like me?
   Why: Trial populations differ from individual patients; ask how closely you match.

Add these to your appointment list, or take the full question set for this cancer.

• ECOG-ACRIN E1910Phase 3NCT020032222024488 peopleevidence 93
  Tests Blinatumomab
  Newly diagnosed Ph-negative B-ALL, age 30-70, in MRD-negative remission after induction: blinatumomab added to consolidation chemotherapy vs chemotherapy alone
  ▸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.

  • 3-year OS 85% vs 68%; HR 0.41.
  Overall survival at 3 years (MRD-negative cohort) (%): Blinatumomab + chemotherapy 85 (n=112) vs Chemotherapy 68 (n=112) · HR 0.41 · source

1. Between Blinatumomab, Inotuzumab ozogamicin and Allogeneic stem cell transplantation, which do you recommend for me, and what about my case would make you choose differently?
   Why: Guidelines list several reasonable options; the choice turns on details of your tumour, your health and your priorities.
2. What is each option trying to achieve: cure, long control, or relief of symptoms, and over what time?
   Why: The aim shapes how much side effect and disruption is worth accepting.
3. How closely do I match the people in ECOG-ACRIN E1910, and does that change what the results mean for me?
   Why: Trial populations are selected; age, fitness, prior treatment and biomarkers all affect how far results carry.
4. Which side effects of Blinatumomab or Inotuzumab ozogamicin are most likely for me, which are reversible, and which would make us stop?
   Why: The recorded rates below come from labels and trials; your own risk depends on dose, other medicines and your health.
5. What happens if I delay, or decline this step for now? Is the decision reversible?
   Why: Some decisions can wait for a second opinion or a trial slot; others cannot. Knowing which is part of the choice.
6. Does your recommendation follow the current guideline (NCCN ALL 2026), and if it departs from it, why?
   Why: Departures from guidelines are sometimes right for an individual; they should be explained.
7. 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.
8. 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.
9. 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.

Add these to your appointment list, or take the full question set for this cancer.

• PhALLCONPhase 3NCT035893262024245 peopleevidence 70
  Tests Ponatinib
  Newly diagnosed Ph-positive ALL, adults: ponatinib vs imatinib, each with reduced-intensity chemotherapy

  MRD-negative CR 34.4% vs 16.7%.

  MRD-negative complete remission at end of induction (%): Ponatinib + chemotherapy 34.4 (n=164) vs Imatinib + chemotherapy 16.7 (n=81) · source
• D-ALBA (GIMEMA LAL2116)Phase 2NCT02744768202063 peopleevidence 68
  Tests Dasatinib, Blinatumomab
  Newly diagnosed Ph-positive ALL, adults of all ages: dasatinib induction followed by blinatumomab, no systemic chemotherapy

  18-month OS 95%, DFS 88%.

  Disease-free survival at 18 months (%): Dasatinib → blinatumomab 88 · source

1. Between Ponatinib, Dasatinib and Blinatumomab, which do you recommend for me, and what about my case would make you choose differently?
   Why: Guidelines list several reasonable options; the choice turns on details of your tumour, your health and your priorities.
2. What is each option trying to achieve: cure, long control, or relief of symptoms, and over what time?
   Why: The aim shapes how much side effect and disruption is worth accepting.
3. How closely do I match the people in PhALLCON and D-ALBA (GIMEMA LAL2116), and does that change what the results mean for me?
   Why: Trial populations are selected; age, fitness, prior treatment and biomarkers all affect how far results carry.
4. Which side effects of Ponatinib or Dasatinib are most likely for me, which are reversible, and which would make us stop?
   Why: The recorded rates below come from labels and trials; your own risk depends on dose, other medicines and your health.
5. What happens if I delay, or decline this step for now? Is the decision reversible?
   Why: Some decisions can wait for a second opinion or a trial slot; others cannot. Knowing which is part of the choice.
6. Does your recommendation follow the current guideline (NCCN ALL 2026), and if it departs from it, why?
   Why: Departures from guidelines are sometimes right for an individual; they should be explained.
7. 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.
8. 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.
9. 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.

Add these to your appointment list, or take the full question set for this cancer.

No trial record is attached to this row yet. The trials tab lists what is recruiting and the landmark trials for this cancer.

1. Between Blinatumomab and Allogeneic stem cell transplantation, which do you recommend for me, and what about my case would make you choose differently?
   Why: Guidelines list several reasonable options; the choice turns on details of your tumour, your health and your priorities.
2. What is each option trying to achieve: cure, long control, or relief of symptoms, and over what time?
   Why: The aim shapes how much side effect and disruption is worth accepting.
3. Which side effects of Blinatumomab are most likely for me, which are reversible, and which would make us stop?
   Why: The recorded rates below come from labels and trials; your own risk depends on dose, other medicines and your health.
4. What happens if I delay, or decline this step for now? Is the decision reversible?
   Why: Some decisions can wait for a second opinion or a trial slot; others cannot. Knowing which is part of the choice.
5. Does your recommendation follow the current guideline (NCCN ALL 2026), and if it departs from it, why?
   Why: Departures from guidelines are sometimes right for an individual; they should be explained.
6. 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.
7. 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.

Add these to your appointment list, or take the full question set for this cancer.

• TOWERPhase 3NCT020131672017405 peopleevidence 93
  Tests Blinatumomab
  Relapsed or refractory Ph-negative B-ALL, adults: blinatumomab vs standard salvage chemotherapy

  OS 7.7 vs 4.0 months; HR 0.71.

  Overall survival (median) (months): Blinatumomab 7.7 (n=271) vs Chemotherapy 4 (n=134) · HR 0.71 · source
• INO-VATE ALLPhase 3NCT015647842016326 peopleevidence 81
  Tests Inotuzumab ozogamicin
  Relapsed or refractory CD22+ B-ALL, adults: inotuzumab ozogamicin vs standard intensive chemotherapy

  CR/CRi 80.7% vs 29.4%; OS 7.7 vs 6.7 months.

  Complete remission / CRi (%): Inotuzumab 80.7 (n=109) vs Chemotherapy 29.4 (n=109) · source
• FELIXPhase 1/2NCT044046602024153 peopleevidence 57
  Tests Obecabtagene autoleucel
  Relapsed or refractory B-ALL, adults: obecabtagene autoleucel single split-dose course

  ORR 77%, CR 55%; grade ≥3 CRS 2.4%.

  Overall remission (CR + CRi) (%): Obe-cel 77 (n=127) · source
• ELIANAPhase 2NCT02435849201879 peopleevidence 62
  Tests Tisagenlecleucel
  Relapsed or refractory B-ALL, patients aged 3-25: single infusion of tisagenlecleucel
  ▸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.

  • ORR 81%; 12-month OS 76%; 5-year OS 55%.
  Overall remission rate within 3 months (%): Tisagenlecleucel 81 (n=75) · source

1. Between Blinatumomab, Inotuzumab ozogamicin, Tisagenlecleucel and the other options, which do you recommend for me, and what about my case would make you choose differently?
   Why: Guidelines list several reasonable options; the choice turns on details of your tumour, your health and your priorities.
2. What is each option trying to achieve: cure, long control, or relief of symptoms, and over what time?
   Why: The aim shapes how much side effect and disruption is worth accepting.
3. How closely do I match the people in TOWER and INO-VATE ALL, and does that change what the results mean for me?
   Why: Trial populations are selected; age, fitness, prior treatment and biomarkers all affect how far results carry.
4. Which side effects of Blinatumomab or Inotuzumab ozogamicin are most likely for me, which are reversible, and which would make us stop?
   Why: The recorded rates below come from labels and trials; your own risk depends on dose, other medicines and your health.
5. What happens if I delay, or decline this step for now? Is the decision reversible?
   Why: Some decisions can wait for a second opinion or a trial slot; others cannot. Knowing which is part of the choice.
6. Does your recommendation follow the current guideline (NCCN ALL 2026), and if it departs from it, why?
   Why: Departures from guidelines are sometimes right for an individual; they should be explained.
7. 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.
8. 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.
9. 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.

Add these to your appointment list, or take the full question set for this cancer.

No trial record is attached to this row yet. The trials tab lists what is recruiting and the landmark trials for this cancer.

1. Between Venetoclax and Allogeneic stem cell transplantation, which do you recommend for me, and what about my case would make you choose differently?
   Why: Guidelines list several reasonable options; the choice turns on details of your tumour, your health and your priorities.
2. What is each option trying to achieve: cure, long control, or relief of symptoms, and over what time?
   Why: The aim shapes how much side effect and disruption is worth accepting.
3. What happens if I delay, or decline this step for now? Is the decision reversible?
   Why: Some decisions can wait for a second opinion or a trial slot; others cannot. Knowing which is part of the choice.
4. Does your recommendation follow the current guideline (NCCN ALL 2026), and if it departs from it, why?
   Why: Departures from guidelines are sometimes right for an individual; they should be explained.
5. 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.
6. 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.

Add these to your appointment list, or take the full question set for this cancer.