Global Challenges in Paediatric Acute Lymphoblastic Leukaemia

Background: Acute lymphoblastic leukaemia (ALL) is the commonest paediatric cancer and represents a fifth of adult leukaemias. Global outcome disparities are linked to variations in socio-demographic indices (SDIs). Summary: In high-SDI regions, established collaborative groups report cure rates surpassing 90% in paediatric ALL. The focus is on reducing treatment toxicity using chemotherapy-free strategies, principally T-cell-directed immunotherapies and targeted small molecules, as exemplified in adult Philadelphia-chromosome-positive ALL. High cure rates limit testing of novel approaches outside niche subgroups, while high costs preclude wider real-world adoption of these advances. Mid-SDI regions (50-80% cure) face challenges in fully implementing contemporary risk-adapted therapy to improve outcomes and reduce costs. This necessitates collaborative practice, standardised high-quality risk-stratification diagnostics, and access to quality-assured generic cytotoxics. Low-SDI regions (<50% cure) report rising disease burden and face more fundamental challenges, including timely diagnosis, access to treatment and expertise, and minimising toxicity and abandonment. Solutions require locally adapted protocols, collaborative partnerships, and sustained patient-support programmes. Key Message: Global partnerships across SDI regions are crucial to address shared challenges in ALL, including access to affordable quality therapeutics, continuing refinement of established treatment elements, tailoring biomarkers for diverse populations, and collaborative frameworks to evaluate new treatments, technologies, and treatment paradigms.