Loading
Leukaemia diagnosed in the first year of life is a different disease from leukaemia in older children: most cases carry a broken KMT2A gene and respond poorly to chemotherapy, and fewer than half of infants were cured for twenty years. One course of the immune drug blinatumomab after induction raised two-year disease-free survival from about half to over 80 percent in a pilot study.
Infant ALL presents with very high white counts, organomegaly, central nervous system involvement and often skin infiltrates. About 75 to 80 percent of cases carry a rearrangement of KMT2A (MLL) with one of many partner genes, commonly AFF1 (AF4), MLLT1 (ENL) or MLLT3 (AF9); the blasts are CD10-negative, express myeloid markers, and can switch lineage to a myeloid phenotype under CD19-directed therapy. KMT2A-rearranged infant leukaemia has one of the quietest genomes in cancer, with almost no other mutations, and depends on the fusion protein's partnership with menin and DOT1L to keep the HOXA gene programme switched on. Age under six months, a white count above 300 x 10^9/L and a poor response to a week of prednisone define the high-risk group.
The Interfant consortium has run the world's infant ALL trials since 1999. Interfant-99 reported four-year event-free survival of 47 percent with a hybrid ALL and AML regimen. Interfant-06, which randomised early intensification with AML-type courses against ALL-type courses, found no difference: six-year event-free survival was 46.1 percent and overall survival 58.2 percent overall, and allogeneic transplant helped only the high-risk group. In 2023 the consortium reported a pilot of 30 KMT2A-rearranged infants given one 28-day course of blinatumomab after Interfant-06 induction: two-year disease-free survival 81.6 percent against 49.4 percent in matched Interfant-06 controls, and overall survival 93.3 percent against 65.8 percent, with no infant relapsing during blinatumomab and no lineage switch in the first two years. Interfant-21 now gives blinatumomab to every KMT2A-rearranged infant.
Menin inhibitors are the targeted therapy this disease waited for: revumenib produced remissions in heavily pretreated KMT2A-rearranged leukaemias in AUGMENT-101, which enrolled infants from 30 days of age, and was approved in November 2024 for relapsed or refractory KMT2A-rearranged acute leukaemia from the age of one; trials are moving it into first-line infant therapy alongside blinatumomab. The unsolved problems are the infants who relapse within the first year despite everything, the very young and very high-count infants for whom transplant remains a blunt tool, lineage switch to myeloid leukaemia under CD19 pressure, the neurotoxicity of intensive chemotherapy given to a developing brain, and the fact that trials in a disease with a few hundred cases a year worldwide take a decade each.
Averages across everyone diagnosed, often years ago. A median is the middle of a group: half the people counted lived longer than the figure shown, and some lived far longer. Your stage, subtype, age, fitness and the treatment you receive matter more than the average, and the numbers are improving quickly.
Infants under one year make up 2 to 4 percent of childhood ALL; about three quarters of them carry a KMT2A rearrangement, and their cure rate has lagged the rest of childhood leukaemia for decades.
Leukaemias, myeloma and MDS live in the marrow and blood; lymphomas grow in lymph nodes and spleen. The node stations are the disease map, not a route of spread, and staging counts them.
In lymphoma the node stations are the disease itself; staging (Ann Arbor / Lugano) counts how many regions and sides of the diaphragm are involved.
Same organ: High-grade B-cell lymphoma with MYC and BCL2 rearrangements (double-hit lymphoma), Mediastinal grey zone lymphoma, Primary effusion lymphoma, Plasmablastic lymphoma, T-cell/histiocyte-rich large B-cell lymphoma, EBV-positive diffuse large B-cell lymphoma, Primary large B-cell lymphoma of the testis, Gastric MALT lymphoma, Ocular adnexal MALT lymphoma, Extranodal NK/T-cell lymphoma, Adult T-cell leukaemia/lymphoma, ALK-positive anaplastic large cell lymphoma, ALK-negative anaplastic large cell lymphoma, Breast implant-associated anaplastic large cell lymphoma, Primary cutaneous anaplastic large cell lymphoma, Lymphomatoid papulosis, Mycosis fungoides, Enteropathy-associated T-cell lymphoma, Monomorphic epitheliotropic intestinal T-cell lymphoma, Extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue (MALT lymphoma), Splenic marginal zone lymphoma, Nodal marginal zone lymphoma, Primary cutaneous marginal zone lymphoma, Primary cutaneous follicle centre lymphoma, Sezary syndrome, Nodal T-follicular helper cell lymphoma, angioimmunoblastic type (angioimmunoblastic T-cell lymphoma), Hepatosplenic T-cell lymphoma, Intravascular large B-cell lymphoma, Lymphomatoid granulomatosis, T-cell prolymphocytic leukaemia, Splenic B-cell lymphoma/leukaemia with prominent nucleoli (formerly B-cell prolymphocytic leukaemia and hairy cell leukaemia variant), T-cell large granular lymphocytic leukaemia, Mixed-phenotype acute leukaemia, Myeloid leukaemia of Down syndrome, Burkitt leukaemia, Marginal zone lymphoma, Cutaneous T-cell lymphoma (mycosis fungoides and Sezary syndrome), Primary mediastinal (thymic) large B-cell lymphoma, Leukaemia (all types), Acute myeloid leukaemia, Acute lymphoblastic leukaemia, Chronic lymphocytic leukaemia, Chronic myeloid leukaemia (CML), Diffuse large B-cell lymphoma, Follicular lymphoma, Hodgkin lymphoma, Mantle cell lymphoma, Multiple myeloma, Non-Hodgkin lymphoma (all types), Myelodysplastic syndromes / neoplasms (MDS), Myeloproliferative neoplasms (PV, ET, myelofibrosis), Polycythaemia vera (PV), Essential thrombocythaemia (ET), Waldenström macroglobulinaemia, Hairy cell leukaemia, Peripheral T-cell lymphomas (including cutaneous T-cell lymphoma), Blastic plasmacytoid dendritic cell neoplasm (BPDCN), Burkitt lymphoma, HIV-associated (AIDS-related) lymphomas, Chronic myelomonocytic leukaemia and MDS/MPN overlap neoplasms, Systemic mastocytosis, Erdheim-Chester disease, Rosai-Dorfman disease and other histiocytic neoplasms, Langerhans cell histiocytosis (LCH), Post-transplant lymphoproliferative disorder (PTLD), FLT3-mutated acute myeloid leukaemia, IDH1- and IDH2-mutated acute myeloid leukaemia, NPM1-mutated and KMT2A-rearranged acute myeloid leukaemia, Secondary and therapy-related acute myeloid leukaemia, Acute promyelocytic leukaemia, Acute myeloid leukaemia in older or unfit patients, Smouldering multiple myeloma, Newly diagnosed multiple myeloma, transplant-eligible, Newly diagnosed multiple myeloma, transplant-ineligible, Relapsed or refractory multiple myeloma, Plasma cell leukaemia, Lower-risk myelodysplastic syndromes, Higher-risk myelodysplastic syndromes, Chronic lymphocytic leukaemia, first treatment, Relapsed or refractory chronic lymphocytic leukaemia, Richter transformation of chronic lymphocytic leukaemia, Chronic myeloid leukaemia, chronic phase, Chronic myeloid leukaemia, accelerated and blast phase, Primary myelofibrosis, Standard-risk B-cell acute lymphoblastic leukaemia in children, High-risk acute lymphoblastic leukaemia in children (high-risk B-ALL and T-ALL), Philadelphia chromosome-positive acute lymphoblastic leukaemia in children (Ph-positive ALL), Philadelphia chromosome-like acute lymphoblastic leukaemia (Ph-like or BCR::ABL1-like ALL), Relapsed and refractory acute lymphoblastic leukaemia in children, Acute myeloid leukaemia in children, Erdheim-Chester disease, Rosai-Dorfman-Destombes disease, Single-system Langerhans cell histiocytosis (bone, skin or one other organ), Multisystem Langerhans cell histiocytosis (with or without risk-organ involvement), Indolent and smouldering systemic mastocytosis, Advanced systemic mastocytosis (aggressive SM, SM with an associated haematological neoplasm, mast cell leukaemia), Early-stage classical Hodgkin lymphoma (stage I to II), Advanced-stage classical Hodgkin lymphoma (stage III to IV), Nodular lymphocyte-predominant Hodgkin lymphoma (nodular lymphocyte-predominant B-cell lymphoma), Relapsed and refractory classical Hodgkin lymphoma
Interfant backbone: a week of prednisone, then dexamethasone, vincristine, cytarabine, daunorubicin and asparaginase with intrathecal therapy.
One 28-day course of blinatumomab after induction (Interfant-21), then Interfant-06 consolidation and maintenance.
Allogeneic transplant in first remission after blinatumomab and consolidation.
Revumenib (approved from the age of one) or trials of menin inhibitors; blinatumomab or CD19 CAR T-cells; transplant.
Country and place are remembered in this browser only. A postcode is sent to OpenStreetMap's Nominatim service to find coordinates when you press the button; nothing else leaves your device.
Blinatumomab after induction is now standard for KMT2A-rearranged infant ALL through the Interfant-21 protocol.
Revumenib proved that a transcriptional dependency, rather than a kinase, can be drugged in leukaemia, opening treatment for two genetic subgroups that together cover roughly a third of AML plus most infant ALL. It is now approved and is being combined with venetoclax-azacitidine and intensive chemotherapy in front-line trials. Single-agent remissions are often short without transplant.
Interfant-06 is the backbone and control benchmark for infant ALL; the successor Interfant-21 adds blinatumomab after this trial showed chemotherapy intensification had reached its limit.
The structure of the paediatric ALL subtype pages, from risk groups to new targeted and immune therapies, follows the framework in this review.
Interfant-99 defined the risk groups and backbone used in Interfant-06 and Interfant-21.
Query for this cancer: (TITLE:"Infant acute lymphoblastic leukaemia" OR ABSTRACT:"Infant acute lymphoblastic leukaemia" OR TITLE:"KMT2A-rearranged, under one year" OR ABSTRACT:"KMT2A-rearranged, under one year" OR TITLE:"Infant ALL" OR ABSTRACT:"Infant ALL" OR TITLE:"KMT2A-rearranged infant leukaemia" OR ABSTRACT:"KMT2A-rearranged infant leukaemia" OR TITLE:"MLL-rearranged infant ALL" OR ABSTRACT:"MLL-rearranged infant ALL") AND (treatment OR therapy OR trial OR survival OR diagnosis). Results are unfiltered search hits about Infant acute lymphoblastic leukaemia (KMT2A-rearranged, under one year), not a curated reading list.
The targets of this cancer's medicines and the ones linked to it directly.
Cases by country, the UK and NHS pathway and other country lenses, the expert centres with trials on record, and the centres named on this cancer's subtypes.
One section per setting: the options named, what each is for, the trials behind them, the recorded trade-offs and the questions to ask.
Bleeding that does not stop by itself, bleeding from more than one site, or new bruising in several places or one large area.
Fever, cough or breathlessness, rapid weight gain or swelling, bone pain, low blood pressure or reduced urine; the labels say to start steroids and monitor at the first suspicion, and the syndrome has been fatal.
Fever of 38 C or higher, chills, low blood pressure, fast heartbeat or breathlessness, especially after a step-up dose. Boxed warning on teclistamab, epcoritamab, glofitamab, tarlatamab and blinatumomab.
Fever of 38 C or higher is grade 1 CRS; fever with low blood pressure, fast heartbeat, breathlessness or low oxygen is grade 2 or higher. The labels carry a boxed warning and say to report fever immediately.
Fatal if given intrathecally: label all syringes.
Known QT prolongation. Avoid other QT-prolonging drugs where possible; check ECG and correct potassium and magnesium before and during treatment.
See all on the product pages:BlinatumomabCytarabineDaunorubicinMethotrexateRevumenibTisagenlecleucelVincristineZiftomenib·Printable cards in the navigator
Newly diagnosed? Read the first 60 days with Infant acute lymphoblastic leukaemia, then print the one-page appointment sheet with room for the answers.
Print this page for your appointment (your browser's print command). These prompts are for discussion; your clinical team knows your case.
Everything in development, the medicines held by this cancer's subtypes, the open problems and what is being done about them, the roadmaps, and what changed on this record.
Every connected record, the notes, the JSON, Markdown and RDF twins, and where the record came from and when it was checked.