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CME: The present and emerging state of the pediatric acute lymphoblastic leukemia (ALL) treatment landscape


Activity Description / Statement of Need:

In this online, self-learning activity:

Advances in ALL management has led to considerable improvements in outcomes over the past several years, with modern-day treatment leading to remission rates of up to 99% and cure rates of about 90% in children with ALL. However, achieving these high rates of response require multiple phases of treatment, including induction, consolidation, interim maintenance, delayed intensification, and maintenance therapy. 

Chemotherapy was previously the standard of care in this setting but is associated with considerable toxicities. Novel, less toxic options are available or being studied for children who have relapsed after treatment as are new pharmacotherapies specific to patients with Philadelphia chromosome–positive disease and novel formulations of asparaginase. Helping the clinician discern the role of each of the first- and subsequent-line novel therapies based on the most up-to-date research merits continuing education programming in ALL. Indeed, a survey of oncology providers revealed that 86% indicated that added professional guidance would be helpful in incorporating more recent therapies into care.

And despite the inclusion of newer agents in pediatric ALL guidelines, a survey of oncologists and other providers who treat patients with the condition found that 40% of respondents had never prescribed, dispensed, or administered them. Challenges include lack of expertise and management of side effects. Furthermore, recently published guidelines, therefore, also inherently suggest a gap in medical practice and justify the need for educational programming.

Target Audience:

HCPs specializing in: pediatric hematology-oncology, hematology, oncology, pathology, and those who otherwise commonly care for or clinically encounter pediatric patients with ALL.

Commercial Support Disclosure: This program is supported by an educational grant from AMGEN.

This activity is free of charge.

Release Date: August 31, 2022 -- Expiration Date: August 31, 2023

Faculty: Joseph Rosenthal, MD, JD


Faculty introduction, disclosures

Introductory content: cursory refresher and review

  • ALL: estimated new cases by age distribution
  • ALL outcomes in pediatric populations
  • Staging and risk assessment
    • Morphology, classification, and prognostic indicators
    • Treatment outcome by minimum residual disease group
  • Advances in molecular biology and impact on diagnosis – biomarker review and updates

Pediatric ALL management

  • NCCN-recommended principles of pediatric treatment approaches
    • Induction chemotherapy, consolidation therapy, and relapsed/refractory disease
    • Limitations of cytotoxic chemotherapy
    • Role for hematopoietic stem cell transplant
  • Treatment for patients with detectable MRD postinduction or postreinduction
    • Clinical trial
    • Chemotherapy
    • Bispecific antibody
    • CAR-T therapy
  • Treatment for relapsed disease
    • Clinical trial
    • Chemotherapy regimens
    • Bispecific antibody
    • CAR-T therapy
    • Off-label antibody-drug conjugate
  • Considerations for Ph+ ALL
    • TKIs to consider
    • Treatment for TKI intolerant or refractory
  • Additional considerations: optimizing and managing asparaginase therapy
  • Supportive care and patient/parent education
  • Patient cases

Summary, conclusions, and best practice recap

Learning Objectives

By the end of the session the participant will be able to:

  • Identify factors affecting the diagnosis, staging, and prognosis of children and adolescents with ALL.
  • Develop pediatric ALL treatment strategies based on the most up-to-date clinical trial findings.
  • Describe the risk-benefit calculus of ALL management strategies and apply them to patient cases, taking into account disease stage, prior treatment, past medical history, and prognostic indicators including detectable MRD.
  • Evaluate a treatment plan, making modifications if necessary, for a patient with ALL based on initial treatment response and the presence of MRD.


ACCME Activity #202333861


Faculty Disclosure and Resolution of COI

As a provider of continuing medical education, it is the policy of ScientiaCME to ensure balance, independence, objectivity, and scientific rigor in all of its educational activities. In accordance with this policy, faculty and educational planners must disclose any significant relationships with commercial interests whose products or devices may be mentioned in faculty presentations, and any relationships with the commercial supporter of the activity. The intent of this disclosure is to provide the intended audience with information on which they can make their own judgments. Additionally, in the event a conflict of interest (COI) does exist, it is the policy of ScientiaCME to ensure that the COI is resolved in order to ensure the integrity of the CME activity. For this CME activity, any COI has been resolved thru content review by ScientiaCME.

Faculty DisclosureJoseph Rosenthal, MD, Barron Hilton Professor and Chair in Pediatrics, Director, Pediatric Hematology/Oncology, City of Hope National Medical Center, has no relevant financial disclosures.

Disclosures of Educational Planners: Charles Turck, PharmD, BCPS, BCCCP, President of ScientiaCME, has no relevant financial disclosures.

Faculty will NOT discuss off-label uses.

All relevant financial relationships have been mitigated.

ScientiaCME adheres to the ACCME’s Standards for Integrity and Independence in Accredited Continuing Education. Any individuals in a position to control the content of a CE activity, including faculty, planners, reviewers or others are required to disclose all relevant financial relationships with ineligible entities (commercial interests). All relevant conflicts of interest have been mitigated prior to the commencement of the activity.

Commercial Support Disclosure: This program is supported by an educational grant from AMGEN.


  • Read the learning objectives above
  • Take the Pre-Test (optional). Completion of the pre-test will help us evaluate the knowledge gained by participating in this CME activity.
  • View the online activity. You may view this is in more than one session, and may pause or repeat any portion of the presentation if you need to.
  • Minimum participation threshold: Take the post-test. A score of 70% or higher is required to pass and proceed to the activity evaluation.
  • Complete the activity evaluation and CME registration. A CE certificate will be emailed to you immediately.

Cultural/Linguistic Competence & Health Disparities

System Requirements

Windows 7 or above
Internet Explorer 8
*Adobe Acrobat Reader
Mac OS 10.2.8
Safari or Chrome or Firefox
*Adobe Acrobat Reader
Internet Explorer is not supported on the Macintosh

*Required to view Printable PDF Version

Perform Pre-Test (optional)

Please take a few minutes to participate in the optional pre-test. It will help us measure the knowledge gained by participating in this activity.

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