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11 standard-of-care settings across 5 lines and 5 biomarker subgroups. Rows come from the cancer page's standard of care; the grid places each on its line and subgroup.
| Line | All comers | Age group | FRα | KMT2A | Ph-positive |
|---|---|---|---|---|---|
| Early / localised | · | 2 | · | · | · |
| Advanced, first line | 2 | · | · | · | 1 |
| Second line | 1 | · | · | · | · |
| Third line and beyond | · | · | 1 | · | · |
| Other settings | 2 | 1 | · | 1 | · |
| Subgroup | Setting | Approach | Products and trials | Guideline | Evidence |
|---|---|---|---|---|---|
| Age group | Children, standard risk B-ALL | Risk-adapted multi-agent chemotherapy (induction, consolidation, interim maintenance, delayed intensification, 2-3 years maintenance) with two cycles of blinatumomab in consolidation (AALL1731, approved June 2024); intrathecal CNS prophylaxis; cranial radiation abandoned for most. | NCCN · Category 1 (blinatumomab in consolidation) | 90 | |
| Age group | Children, high risk or MRD-positive | Intensified chemotherapy; blinatumomab for MRD persistence (AALL1331 in relapse); inotuzumab and CAR-T (tisagenlecleucel) for relapse; allogeneic transplant for very high risk or MRD persistence. | NCCN · Category 2A | 92 |
| Subgroup | Setting | Approach | Products and trials | Guideline | Evidence |
|---|---|---|---|---|---|
| All comers | Frontline | Risk-adapted chemotherapy + blinatumomab consolidation; TKI if Ph+. | NCCN Guidelines: Acute Lymphoblastic Leukemia | 85 | |
| All comers | MRD-positive after induction or consolidation | Blinatumomab (BLAST; full approval 2018) to convert to MRD negativity, then transplant or continued blinatumomab-based therapy. | NCCN · Category 1 | 92 | |
| Ph-positive | Ph-positive ALL, newly diagnosed | Ponatinib (PhALLCON) or dasatinib with reduced-intensity chemotherapy, or chemotherapy-free TKI + blinatumomab (D-ALBA); BCR::ABL1 PCR monitoring; transplant for MRD persistence or IKZF1-plus, increasingly omitted for MRD-negative patients. | NCCN · Category 2A (ponatinib preferred TKI) | 85 |
| Subgroup | Setting | Approach | Products and trials | Guideline | Evidence |
|---|---|---|---|---|---|
| All comers | Relapsed | CAR-T (tisagenlecleucel, obe-cel), inotuzumab, transplant. | NCCN Guidelines: Acute Lymphoblastic Leukemia | 89 |
| Subgroup | Setting | Approach | Products and trials | Guideline | Evidence |
|---|---|---|---|---|---|
| FRα | Relapsed or refractory B-ALL | Blinatumomab (TOWER) or inotuzumab (INO-VATE) as salvage and bridge; CD19 CAR-T (tisagenlecleucel ≤25 years; obe-cel or brexucabtagene in adults) for second salvage or as definitive therapy; transplant for those not previously transplanted; CD22 or dual CAR-T for CD19-negative relapse in trials. | NCCN · Category 2A | 93 |
| Subgroup | Setting | Approach | Products and trials | Guideline | Evidence |
|---|---|---|---|---|---|
| All comers | Adults 40-70, Ph-negative | Hyper-CVAD or age-adapted multi-agent chemotherapy with blinatumomab interleaved in consolidation (E1910); inotuzumab-containing lower-intensity regimens (Mini-hyper-CVD + InO ± blinatumomab) for older adults; MRD-driven transplant. | NCCN · Category 1 (E1910 regimen) | 93 | |
| All comers | T-cell ALL | Intensive paediatric-type chemotherapy with nelarabine for high-risk (AALL0434); relapse: nelarabine, venetoclax combinations, CD7 CAR-T and daratumumab in trials; transplant in CR2. | NCCN · Category 2A | 92 | |
| Age group | Adolescents and young adults (15-39), Ph-negative | Paediatric-inspired regimens (CALGB 10403, GRAALL, UKALL) with asparaginase; blinatumomab consolidation (E1910); MRD-guided transplant. | NCCN · Category 1 (blinatumomab consolidation) | 93 | |
| KMT2A | Infants (<1 year), KMT2A-rearranged | Interfant-21 backbone with blinatumomab; transplant for high-risk; menin inhibitors in trials. | NCCN · Clinical trial preferred | 85 |
Lines and subgroups are parsed from the setting text of each standard-of-care row and can misclassify an unusual phrasing; the row’s own setting is always shown. Guideline chips reflect the NCCN category and ESMO-MCBS grade recorded on the cancer page, checked on its stated date. Not medical advice.