Describe the current standard of care for acute lymphoblastic leukaemia (ALL) in adults and children.
Management of Acute Lymphoblastic Leukaemia (ALL)
The standard of care for ALL involves intensive, multi-phase chemotherapy, tailored differently for pediatric and adult patients due to variations in disease biology and treatment tolerance.
Children with ALL:
Children generally have a favorable prognosis and tolerate intensive therapy well. Induction aims to achieve complete remission (<5% blasts in bone marrow) and typically uses vincristine, corticosteroids (prednisone or dexamethasone), L-asparaginase, and an anthracycline such as daunorubicin. Consolidation/Intensification eradicates residual leukemia, often combining methotrexate, mercaptopurine, cytarabine, and other agents. Treatment intensity is guided by risk stratification, including cytogenetics and minimal residual disease (MRD). Maintenance therapy is prolonged (2–3 years) with daily oral mercaptopurine, weekly methotrexate, and intermittent vincristine plus corticosteroids. CNS prophylaxis using intrathecal methotrexate, cytarabine, and hydrocortisone is essential to prevent relapse. Targeted therapy with tyrosine kinase inhibitors is used in Ph+ ALL.
Adults with ALL:
Adult protocols are more intensive due to higher disease burden and poorer prognosis. Induction and consolidation are prolonged with similar agents. Maintenance lasts 1–2 years. Allogeneic hematopoietic stem cell transplantation (allo-HSCT) is indicated in high-risk adults or those with persistent MRD. Targeted therapies include TKIs, blinatumomab for relapsed/refractory cases, and CAR T-cell therapy for resistant disease.
Throughout treatment, vigilant supportive care—including infection prophylaxis, transfusions, nutritional support, and monitoring for organ toxicity—is critical to optimize outcomes and minimize therapy-related complications.
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