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10 slides generated from the cancer page, with a quiz from the open benchmark and speaker notes that cite the sources. Arrow keys move between slides; Print gives one slide per page.
Acute lymphoblastic leukaemia is the childhood cancer success story, and was the first disease treated with CAR-T and with a T-cell engager.
Acute lymphoblastic leukaemia is the commonest childhood cancer and a rarer, harder disease in adults. B-cell precursor ALL (85%) is classified by genetics into favourable (ETV6::RUNX1, high hyperdiploidy), intermediate, and adverse groups (KMT2A rearrangement, hypodiploidy, Ph-like/CRLF2, iAMP21, TCF3::HLF); Ph-positive (BCR::ABL1) disease accounts for a quarter of adult cases. T-ALL (15%) has its own genetics and, since 2023, its own targeted options (nelarabine, BCL-2 inhibition in trials). Measurable residual disease after induction is the strongest predictor of relapse in every subgroup.
Children are cured in over 90% with risk-adapted multi-agent chemotherapy over two to three years, and since 2024 with blinatumomab woven into consolidation (AALL1731: 3-year DFS 96% vs 88%). Adults do worse with chemotherapy alone, but three immunotherapies changed the picture: blinatumomab (E1910: 3-year OS 85% vs 68% when added frontline; standard in MRD-positive and relapsed disease), the CD22 ADC inotuzumab ozogamicin (INO-VATE: 81% remission in relapse), and CD19 CAR-T (tisagenlecleucel for patients up to 25; obe-cel for adults, 2024). Ph-positive ALL is treated with a BCR::ABL1 inhibitor (ponatinib preferred since PhALLCON, 2024) and increasingly with TKI plus blinatumomab and no chemotherapy at all (D-ALBA), while KMT2A-rearranged disease now has menin inhibitors.
| Setting | Approach | Guideline |
|---|---|---|
| Frontline | Risk-adapted chemotherapy + blinatumomab consolidation; TKI if Ph+. | not mapped |
| Relapsed | CAR-T (tisagenlecleucel, obe-cel), inotuzumab, transplant. | not mapped |
| 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) |
| 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 |
| Infants (<1 year), KMT2A-rearranged | Interfant-21 backbone with blinatumomab; transplant for high-risk; menin inhibitors in trials. | NCCN Clinical trial preferred |
| 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) |
| 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) |
| 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) |