Acute lymphoblastic leukemia (ALL) is a rapidly progressing blood cancer that requires prompt initiation of structured induction therapy. The immediate clinical priority is achieving a complete remission — clearing blast cells from the bone marrow and restoring normal blood counts — within the first cycle of treatment.

Clinical Scenario

This protocol applies to newly diagnosed ALL. Treatment intensity and agent selection are guided by individual risk stratification, with the overarching aim of driving the disease into complete remission as efficiently as possible through a defined induction phase.

Treatment Approach (partial overview)

Induction therapy combines multiple chemotherapy drug classes — anchored by a corticosteroid alongside agents targeting rapidly dividing lymphoblasts — with concurrent CNS-directed treatment. In some patients, a monoclonal antibody is incorporated based on disease characteristics. The complete risk-stratified regimen, full agent selection, and sequencing are detailed in the full protocol.

Treatment Goals

At the end of induction (approximately 4 weeks), the target is complete remission: no more than 5% blast cells in the bone marrow, no blasts detectable in peripheral blood, blood counts returned to normal or near normal, and resolution of all signs and symptoms of ALL.

References

Chemotherapy induction regimens for ALL generally use a combination of drugs that include vincristine; an anthracycline (daunorubicin or doxorubicin); and a corticosteroid (prednisone or dexamethasone).
Based on their risk group, some patients may also receive cyclophosphamide or pegaspargase.
In addition to chemotherapy, patients may also receive a monoclonal antibody such as inotuzumab ozogamicin (Besponsa®), ofatumumab (Kesimpta®) or rituximab (Rituxan®).
Intrathecal chemotherapy, in which anticancer drugs are injected into the fluid-filled space between the thin layers of tissue that cover the brain and spinal cord. These drugs may include methotrexate, cytarabine, and corticosteroids (typically, hydrocortisone).
Induction therapy often lasts about 4 weeks.
No more than 5 percent of cells in the bone marrow are blast (immature) cells; no blasts are found in the blood; blood cell counts are back to normal/near normal; all signs and symptoms of ALL are gone.

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What Is the First-Line Treatment of Acute Lymphoblastic Leukemia?

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