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Updated: May 16, 2026
Murine Model of Leukemia Relapse to Induction Chemotherapy for Acute Lymphoblastic Leukemia
Published on: October 17, 2025
Where do we stand in the treatment of relapsed acute lymphoblastic leukemia?
Elizabeth A Raetz1, Teena Bhatla
1Division of Pediatric Hematology/Oncology, New York University Langone Medical Center, New York, NY, USA. elizabeth.raetz@nyumc.org
Insights
Relapsed childhood acute lymphoblastic leukemia (ALL) has poor outcomes despite salvage therapy. Genomic analysis of diagnostic and relapse samples offers a promising approach to identify new chemoresistance pathways.
Area of Science:
- Pediatric Oncology
- Cancer Genomics
Background:
- Acute lymphoblastic leukemia (ALL) is a common childhood cancer, with most patients cured.
- However, 10%-20% of children with ALL experience disease relapse, facing poor long-term survival rates after salvage therapy.
Purpose of the Study:
- To address the disappointing outcomes of salvage therapy for relapsed childhood ALL.
- To explore novel strategies for treating recurrent ALL, focusing on its unique biology and chemoresistance mechanisms.
Main Methods:
- Review of prognostic factors for relapsed ALL, emphasizing timing and site of recurrence.
- Discussion of limitations of current intensive salvage regimens.
- Highlighting the emerging role of high-resolution genomic analyses of diagnostic and relapse bone marrow samples.
Main Results:
- Outcomes for relapsed ALL have remained static despite international trial variations.
- Timing of recurrence and site of relapse are key prognostic variables.
- Genomic analyses are identifying pathways contributing to chemoresistance.
Conclusions:
- Current salvage therapies for relapsed ALL have reached their limit of tolerability.
- Future strategies must focus on developing novel agents targeting the biology of relapsed disease.
- Genomic insights into chemoresistance pathways are crucial for improving treatment efficacy.
Abstract:
Acute lymphoblastic leukemia (ALL) is the most common and one of the most treatable cancers in children. Although the majority of children with ALL are now cured, 10%-20% of patients are predicted to relapse and outcomes with salvage therapy have been disappointing, with approximately only one-third of children surviving long-term after disease recurrence. Several prognostic factors have been identified, with timing of recurrence relative to diagnosis and site of relapse emerging as the most important variables. Despite heterogeneity in the elements of salvage therapy that are delivered in trials conducted internationally, outcomes have been remarkably similar and have remained static. Because most intensive salvage regimens have reached the limit of tolerability, current strategies are focusing on identifying new agents tailored to the unique biology of relapsed disease and identifying methods to develop these agents efficiently for clinical use. Recently, high-resolution genomic analyses of matched pairs of diagnostic and relapse bone marrow samples are emerging as a promising tool for identifying pathways that impart chemoresistance.
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