# Acute lymphoblastic leukemia: an update on treatment and Brazilian perspective **Authors:** Bruno Terra Correa, Gabriela Sales Serra Silva, Webert Joaquim Silva Mendes, Laryssa Lopes Soares, Joice Antunes Lima, Catarina Graziela Sousa Pereira, João Vitor Torquato de Souza, Maria Eduarda Freire dos Santos, Augusto Cezar Magalhães Aleluia, Caroline Conceição da Guarda, Regiana Quinto Souza Póvoas, Marilda de Souza Gonçalves, Milena Magalhães Aleluia PMC · DOI: 10.3389/fonc.2026.1637924 · Frontiers in Oncology · 2026-02-13 ## TL;DR This paper reviews the current state of ALL treatment and highlights challenges in Brazil, emphasizing the need for better access to advanced therapies. ## Contribution The paper provides a Brazilian perspective on ALL treatment and emphasizes the need for improved healthcare access and local research. ## Key findings - ALL treatment has evolved to include multi-phase chemotherapy and CAR T-cell therapy, improving survival rates. - Survival disparities persist due to socioeconomic and healthcare access inequalities in developing countries. - Brazilian studies highlight the importance of local research and improved access to diagnostics and therapies. ## Abstract Acute lymphoblastic leukemia (ALL) is the most common pediatric cancer, representing a major global health concern, particularly in developing countries. This review provides an updated overview of the epidemiology, diagnosis, prognosis, treatment, and a Brazilian perspective for ALL. Despite advances in chemotherapy and immunotherapy, survival disparities remain challenging, driven by socioeconomic and healthcare access inequalities. Present diagnosis incorporates immunophenotyping, cytogenetics, and molecular biology for precise stratification and treatment planning. Treatment has evolved from monotherapy to multi-phase chemotherapy protocols, hematopoietic stem cell transplantation, monoclonal antibodies, and CAR T-cell therapy with risk-adapted strategies improving outcomes and offering hope in relapsed or refractory cases. However, these treatments remain largely inaccessible in low-to middle-income countries. Our review summarizes findings from Brazilian studies in children with ALL about diagnostics and treatment and highlights the importance of an accurate understanding of the national reality. Improved access to diagnostics, novel therapies, local multi-center studies, and pharmaceutical investment to enhance survival and quality of life for pediatric ALL patients is needed. ## Linked entities - **Diseases:** Acute lymphoblastic leukemia (MONDO:0004967), ALL (MONDO:0004967) ## Full-text entities - **Genes:** RUNX1 (RUNX family transcription factor 1) [NCBI Gene 861] {aka AML1, AML1-EVI-1, AMLCR1, CBF2alpha, CBFA2, EVI-1}, BCR (BCR activator of RhoGEF and GTPase) [NCBI Gene 613] {aka ALL, BCR1, CML, D22S11, D22S662, PHL}, CD19 (CD19 molecule) [NCBI Gene 930] {aka B4, CVID3}, CD4 (CD4 molecule) [NCBI Gene 920] {aka CD4mut, IMD79, Leu-3, OKT4D, T4}, TXK (TXK tyrosine kinase) [NCBI Gene 7294] {aka BTKL, PSCTK5, PTK4, RLK, TKL}, CRLF2 (cytokine receptor like factor 2) [NCBI Gene 64109] {aka CRL2, CRLF2Y, TSLPR}, ETV6 (ETS variant transcription factor 6) [NCBI Gene 2120] {aka TEL, TEL/ABL, THC5}, JAK2 (Janus kinase 2) [NCBI Gene 3717] {aka JTK10}, CD22 (CD22 molecule) [NCBI Gene 933] {aka SIGLEC-2, SIGLEC2}, MPO (myeloperoxidase) [NCBI Gene 4353], CD7 (CD7 molecule) [NCBI Gene 924] {aka GP40, LEU-9, TP41, Tp40}, DNTT (DNA nucleotidylexotransferase) [NCBI Gene 1791] {aka TDT}, IKZF1 (IKAROS family zinc finger 1) [NCBI Gene 10320] {aka CVID13, Hs.54452, IK1, IKAROS, LYF1, LyF-1}, CD38 (CD38 molecule) [NCBI Gene 952] {aka ADPRC 1, ADPRC1, cADPR1}, CD8A (CD8 subunit alpha) [NCBI Gene 925] {aka CD8, CD8alpha, IMD116, Leu2, p32}, ABL1 (ABL proto-oncogene 1, non-receptor tyrosine kinase) [NCBI Gene 25] {aka ABL, BCR-ABL, CHDSKM, JTK7, bcr/abl, c-ABL}, CD79A (CD79a molecule) [NCBI Gene 973] {aka IGA, IGAlpha, MB-1, MB1}, MME (membrane metalloendopeptidase) [NCBI Gene 4311] {aka CALLA, CD10, CMT2T, NEP, SCA43, SFE}, KRT20 (keratin 20) [NCBI Gene 54474] {aka CD20, CK-20, CK20, K20, KRT21}, PAX5 (paired box 5) [NCBI Gene 5079] {aka ALL3, BSAP, PAX-5} - **Diseases:** Acute leukemias (MESH:D015470), pallor (MESH:D010167), gingival bleeding (MESH:D005884), cell (MESH:D002292), tachycardia (MESH:D013610), chronic graft-versus-host disease (MESH:D000092122), bleeding (MESH:D006470), leukopenia (MESH:D007970), release syndrome (MESH:C566759), petechiae (MESH:D011693), Hodgkin's and non-Hodgkin's lymphomas (MESH:D008228), T-cell leukemia (MESH:D015458), epistaxis (MESH:D004844), chronic lymphoid leukemia (MESH:D007945), weakness (MESH:D018908), Down's syndrome (MESH:D004314), ALL (MESH:D054198), ataxia-telangiectasia (MESH:D001260), thrombocytopenia (MESH:D013921), Cancer (MESH:D009369), chromosomal abnormalities (MESH:D002869), cell ALL (MESH:D054218), multiple myeloma (MESH:D009101), neurotoxicity (MESH:D020258), dyspnea (MESH:D004417), infection (MESH:D007239), GVHD (MESH:D006086), B-cell ALL (MESH:D015456), toxicity (MESH:D064420), anemia (MESH:D000740), Alcohol abuse (MESH:D000437), viral infections (MESH:D014777), leukemia (MESH:D007938), cytopenias (MESH:D006402), death (MESH:D003643) - **Chemicals:** Inotuzumab ozogamicin (MESH:D000080045), potassium chloride (MESH:D011189), PEG-asparaginase (MESH:C042705), folic acid (MESH:D005492), cyclophosphamide (MESH:D003520), MTX (MESH:D008727), Daratumumab (MESH:C556306), Ofatumumab (MESH:C527517), prednisone (MESH:D011241), cytarabine (MESH:D003561), daunomycin (MESH:D003630), ifosfamide (MESH:D007069), benzene (MESH:D001554), vindesine (MESH:D014751), Epratuzumab (MESH:C448700), imatinib (MESH:D000068877), vincristine (MESH:D014750), hydrocortisone (MESH:D006854), Rituximab (MESH:D000069283), dexamethasone (MESH:D003907), 6-mercaptopurine (MESH:D015122), aminopterin (MESH:D000630), etoposide (MESH:D005047), Blinatumomab (MESH:C510808), prednisolone (MESH:D011239), BFM (-), 6-thioguanine (MESH:D013866), doxorubicin (MESH:D004317) - **Species:** Homo sapiens (human, species) [taxon 9606] ## Full text _Full body text omitted from this summary view._ Fetch the complete paper as Markdown: https://tomesphere.com/paper/PMC12945779/full.md ## References 90 references — full list in the complete paper: https://tomesphere.com/paper/PMC12945779/full.md --- Source: https://tomesphere.com/paper/PMC12945779