Front-line Treatment of B-cell Acute Lymphoblastic Leukemia in Canada: Current Strategies and Evolving Paradigms

The treatment landscape for adults with B-cell acute lymphoblastic leukemia (B-ALL) has evolved considerably, with pediatric-inspired regimens, targeted therapies, and measurable residual disease (MRD)-guided approaches improving outcomes. However, treatment strategies in the clinic remain highly variable due to heterogeneity in prospective trials, a lack of randomized comparative data, and the continued evolution of therapies—particularly with the increasing use of targeted agents and immunotherapies in the front-line setting. The absence of national standardization further contributes to variability in clinical practice. This review provides an overview of current front-line treatment strategies for B-ALL in Canada, highlighting key therapeutic approaches and recent advancements in optimizing care.