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Induction, consolidation, maintenance and CNS prophylaxis — why ALL treatment is a marathon
Acute lymphoblastic leukemia (ALL) is a malignancy of immature lymphoid cells. It is the most common childhood cancer but also occurs in adults, where outcomes remain inferior. Diagnosis relies on marrow morphology, flow cytometry and genetic characterisation. Treatment is prolonged and includes induction, consolidation, central nervous system prophylaxis and maintenance, with allogeneic transplant for selected high-risk patients.
Haematology & Haemato-Oncology
Authored and reviewed by Dr. Sachita Baniya (MBBS, FCPS (Clinical Haematology), NMC 20158). Evidence-based, no fabricated outcomes.
Acute lymphoblastic leukemia (ALL) is a malignancy of immature lymphoid cells. It is the most common childhood cancer but also occurs in adults, where outcomes remain inferior. Diagnosis relies on marrow morphology, flow cytometry and genetic characterisation. Treatment is prolonged and includes induction, consolidation, central nervous system prophylaxis and maintenance, with allogeneic transplant for selected high-risk patients.
Reviewed by Dr. Sachita Baniya, MBBS, FCPS — Consultant Haemato-Oncologist & Clinical Hematologist (NMC 20158). For evaluation, contact the respective hospital or cancer centre — Kathmandu Cancer Center (KCC) Nepal, Civil Service Hospital Kathmandu, or Advanced Care Hospital.
Flow cytometry establishes B- or T-lineage and maturation stage. Cytogenetics and molecular testing identify defining lesions such as BCR-ABL1, KMT2A rearrangements, ETV6-RUNX1 and Ph-like signatures. Minimal residual disease after induction is one of the strongest predictors of outcome and guides subsequent decisions.
Treatment begins with induction to clear marrow blasts, followed by consolidation and CNS-directed therapy, then prolonged maintenance for B-ALL. Ph-positive ALL incorporates tyrosine kinase inhibitors. Allogeneic transplant is considered for high-risk disease, poor MRD response or relapse. Supportive care — infection prevention, transfusion and monitoring for tumour lysis — is integral throughout.
Guidelines referenced:
NCCN Guidelines — Acute Lymphoblastic LeukemiaESMO Clinical Practice Guidelines — Acute Lymphoblastic LeukemiaWHO Classification of Haematopoietic and Lymphoid TumoursContent on this website is for general educational purposes only and does not constitute medical advice, diagnosis, or treatment. It is not a substitute for evaluation by a qualified healthcare professional. Always seek the advice of your physician or other qualified provider with any questions regarding a medical condition. Never disregard professional medical advice or delay seeking it because of something you have read on this website. In case of a medical emergency, contact emergency services immediately. No doctor–patient relationship is established by use of this site or by contacting the clinic through the site.