Abstract
Cure rates for acute lymphoblastic leukemia (ALL), the most common
childhood cancer have steadily improved over the past five decades. This
is due to intensifying systemic therapy, recognizing and treating the
central nervous system as a sanctuary site, and implementing modern risk
stratification to deliver varying intensities of therapy based on age,
presenting white blood count (WBC), sentinel somatic genetics, and
therapy response. Recently, numerous Children’s Oncology Group trials
have demonstrated the lack of benefit of intensifying traditional
chemotherapy, providing evidence that new approaches are needed to cure
the patients for whom cure has been elusive. Distinguishing those who
require intensive or novel therapeutic approaches from others who will
be cured with minimal therapy is key for future trials. Incorporating
new genomic biomarkers and more sensitive measures of minimal/measurable
residual disease (MRD) provide opportunities to achieve these goals.