Acute lymphoblastic leukemia (ALL) is a malignant tumor disease characterized by abnormal proliferation of B or T cells originating from lymphocytes in the bone marrow. Its characteristic is the accumulation of abnormally proliferating primitive cells in the bone marrow, which inhibits normal hematopoietic function and can invade tissues outside the bone marrow, such as meninges, lymph nodes, gonads, liver, etc.

The etiology of ALL is not fully understood, but it is related to factors such as genetics, environment, and genetic changes. About 5% of ALL cases are related to genetic factors, and ionizing radiation and chemicals such as benzene and its analogues are also considered important triggers. Its common symptoms include anemia, fever, infection, bleeding, as well as lymphadenopathy, liver and spleen enlargement, bone and joint pain, etc.

ALL is particularly common in children, with a peak incidence between the ages of 0 and 9, accounting for over 70% of childhood leukemia cases. In adults, ALL accounts for about 20% of adult leukemia. China has conducted a survey on the incidence of leukemia. The incidence rate of ALL is about 0.67/100000, and the incidence rate of oil fields and polluted areas is significantly higher than the national incidence rate.

The treatment plan for ALL includes induction therapy, consolidation therapy, maintenance therapy, and shelter (including central nervous system and testicular) therapy. In recent years, with the advancement of medical technology, significant progress has been made in the treatment of ALL.

Induced remission therapy: using chemotherapy drugs to minimize leukemia cells and achieve complete remission. The commonly used chemotherapy drugs include VDCP regimen (vincristine, erythromycin, cyclophosphamide, prednisone), and may be combined with drugs such as asparaginase.

Consolidation and reinforcement therapy: After achieving complete remission, it is necessary to continue consolidation therapy to eliminate residual leukemia cells. In the latest treatment plan, Inotuzumab ozogamicin ± TKI (tyrosine kinase inhibitor) is used for consolidation therapy, especially in the presence of minimal residual disease (MRD), which may improve patient prognosis.

Maintenance therapy: Long term maintenance therapy is crucial for preventing recurrence. For high-risk patients, allogeneic hematopoietic stem cell transplantation is also an effective treatment option.

Central nervous system prevention and treatment: Due to the easy invasion of the central nervous system by ALL, intrathecal injection of chemotherapy drugs for prevention and treatment is necessary.

New drugs and immunotherapy: In recent years, bispecific T cell junction molecules such as bevacizumab have also been used for the treatment of ALL, especially in patients with relapsed/refractory B-cell ALL, achieving significant therapeutic effects.

In summary, the treatment of acute lymphoblastic leukemia is a complex and systematic process that requires a comprehensive consideration of multiple factors such as the patient's age, condition, and prognosis to develop individualized treatment plans. With the continuous advancement of medical technology, the treatment effectiveness of ALL is also constantly improving.