How I treat relapsed childhood acute lymphoblastic leukemia

The most common cause of treatment failure in childhood acute lymphoblastic leukemia (ALL) remains relapse, occurring in ? 15%-20% of patients. Survival of relapsed patients can be predicted by site of relapse, length of first complete remission, and immunophenotype of relapsed ALL. BM and early relapse (< 30 months from diagnosis), as well as T-ALL, are associated with worse prognosis than isolated extramedullary or late relapse (> 30 months from diagnosis).