Acute lymphoblastic leukemia
ICD-10 C91.0 · ICD-11 2B33.3

Relapsed or Primary Refractory ALL After Conventional Salvage Chemotherapy Has Failed

Acute lymphoblastic leukemia can recur or fail to respond to initial treatment in a significant proportion of patients. When conventional salvage chemotherapy has not achieved a new complete remission, a structured next-line protocol applies.

Clinical Scenario

Relapsed or primary refractory acute lymphoblastic leukemia. Depending on protocol and subtype, 5% to 10% of patients will be primary refractory, and an additional 30% to 60% will relapse.

When the Previous Line Falls Short

Conventional salvage chemotherapy achieves a new complete remission in only 20% to 40% of patients with relapsed or refractory ALL. Failure to reach this goal is the indication for escalation to this next-line protocol.

Next-Line Approach (Partial Overview)

An immunotherapy-based approach is available for this setting, with agent selection guided by disease-specific features.

Full regimen details — including specific agents, eligibility criteria, and dosing — are in the complete protocol below.

Treatment Goal

Achievement of complete remission or complete remission with incomplete recovery (CR/CRi).

Instant Access to Structured Evidence-Based Regimens

References

DOI: 10.1182/blood.2023023568

Depending on protocol and subtype, 5% to 10% of patients will be primary refractory, and an additional 30% to 60% of patients will relapse.

InO has been approved for R/R CD22-positive ALL based on a randomized study, the rate of CR/CRi was 81% after InO vs 33% after standard salvage chemotherapy.

Blina has been approved for R/R ALL based on a randomized study.

One might propose favoring Blina in patients with relatively low disease burden and preserved T-cell functions, whereas InO might be used to reduce high disease burden though trials were limited to patients with peripheral blasts <10 000/μL.

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