High-risk acute lymphoblastic leukaemia in children (high-risk B-ALL and T-ALL): lines of therapy
5 standard-of-care settings across 4 lines and 2 biomarker subgroups. Rows come from the cancer page's standard of care; the grid places each on its line and subgroup.
Early / localised
| Subgroup | Setting | Approach | Products and trials | Guideline | Evidence |
|---|---|---|---|---|---|
| Risk group | Very high risk: induction failure, hypodiploidy, persistent residual disease | Blinatumomab to clear residual disease, then allogeneic transplant in first remission; CD19 CAR T-cells as consolidation in trials. | NCI PDQ: Childhood Acute Lymphoblastic Leukemia Treatment (health professional version) | 92 |
Advanced, first line
| Subgroup | Setting | Approach | Products and trials | Guideline | Evidence |
|---|---|---|---|---|---|
| All comers | Induction (four weeks) | Four-drug induction: vincristine, dexamethasone or prednisone, daunorubicin and pegylated asparaginase with intrathecal methotrexate; MRD at day 29. | NCI PDQ: Childhood Acute Lymphoblastic Leukemia Treatment (health professional version) | 78 |
Maintenance
| Subgroup | Setting | Approach | Products and trials | Guideline | Evidence |
|---|---|---|---|---|---|
| All comers | Delayed intensification and maintenance | Two delayed intensification blocks with vincristine, dexamethasone, doxorubicin, cyclophosphamide, cytarabine and thioguanine; maintenance with mercaptopurine, methotrexate and vincristine-steroid pulses. | NCI PDQ: Childhood Acute Lymphoblastic Leukemia Treatment (health professional version) | 79 | |
| Risk group | Consolidation and interim maintenance, high-risk B-ALL | Augmented BFM consolidation with cyclophosphamide, cytarabine, mercaptopurine and asparaginase; high-dose methotrexate with leucovorin rescue (AALL0232); blinatumomab or inotuzumab ozogamicin added in current trials. | NCI PDQ: Childhood Acute Lymphoblastic Leukemia Treatment (health professional version) | 85 |
Other settings
| Subgroup | Setting | Approach | Products and trials | Guideline | Evidence |
|---|---|---|---|---|---|
| All comers | T-cell ALL | Augmented BFM with Capizzi escalating methotrexate and nelarabine courses for intermediate- and high-risk disease (AALL0434); cranial irradiation only for CNS3 or the highest risk (AALL1231). | NCI PDQ: Childhood Acute Lymphoblastic Leukemia Treatment (health professional version) | 78 |
Lines and subgroups are parsed from the setting text of each standard-of-care row and can misclassify an unusual phrasing; the row’s own setting is always shown. Guideline chips reflect the NCCN category and ESMO-MCBS grade recorded on the cancer page, checked on its stated date. Not medical advice.