Most adults with ALL relapse and require rescue treatment; rescue treatment usually has a poor outcome (40-50% rate of complete remission). The design of this treatment will depend on:

- previous treatments

- duration of first remission

- overall health of the patient

- organ function

The most widely used drug combinations to treat recurrent disease are:

- vincristine, anthracycline, and steroids

- methotrexate and L-asparaginase

- combination of high-dose cytarabine

All of the above are combined with the following regimens:

  • HyperCVAD WITH L-asparaginase (cyclophosphamide, vincristine, doxorubicin, and dexamethasone)
  • FLAG including cytarabine at high doses, fludarabine, and anthracycline
  • MOAD (methotrexate, dexamethasone, vincristine, and L-asparaginase)
  • Induction treatment is repeated if remission has lasted for more than 2 years.