Relapsed and refractory acute lymphoblastic leukaemia in children: lines of therapy
5 standard-of-care settings across 2 lines and 4 biomarker subgroups. Rows come from the cancer page's standard of care; the grid places each on its line and subgroup.
Second line
| Subgroup | Setting | Approach | Products and trials | Guideline | Evidence |
|---|---|---|---|---|---|
| All comers | First relapse: reinduction | Mitoxantrone-based reinduction (UKALLR3) with vincristine, dexamethasone, asparaginase and intrathecal therapy; MRD after the block sets the path. | NCI PDQ: Childhood Acute Lymphoblastic Leukemia Treatment (health professional version) | 78 | |
| All comers | Relapsed T-cell ALL | Nelarabine with cyclophosphamide and etoposide, then allogeneic transplant; venetoclax combinations and CD7 CAR T-cells in trials. | NCI PDQ: Childhood Acute Lymphoblastic Leukemia Treatment (health professional version) | 92 | |
| KMT2A | Relapsed KMT2A-rearranged ALL | Revumenib (approved from the age of one) alone or in trials with chemotherapy, as a bridge to transplant. | NCI PDQ: Childhood Acute Lymphoblastic Leukemia Treatment (health professional version) | 92 | |
| Risk group | First relapse, high or intermediate risk: consolidation | Blinatumomab in place of chemotherapy blocks (AALL1331, IntReALL), then allogeneic transplant in MRD-negative remission. | NCI PDQ: Childhood Acute Lymphoblastic Leukemia Treatment (health professional version) | 92 |
Third line and beyond
| Subgroup | Setting | Approach | Products and trials | Guideline | Evidence |
|---|---|---|---|---|---|
| FRα | Second or later relapse, or refractory disease | Tisagenlecleucel (ELIANA) or inotuzumab ozogamicin, with transplant after inotuzumab and after CAR T-cells in selected children. | NCI PDQ: Childhood Acute Lymphoblastic Leukemia Treatment (health professional version) | 92 |
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.