Summary Acute lymphoblastic leukemia (ALL) is the most common childhood cancer and one of the major success stories of modern medicine. Cure rates now approach 90–95%, largely because of multinational risk-adapted intensive protocols, optimized central nervous system prophylaxis, improved supportive care, and genetics- and minimal residual disease (MRD)-guided treatment stratification. Nevertheless, relapse remains the leading cause of death, and the current acute and long-term burden of intensive polychemotherapy is substantial. Blinatumomab, a CD19/CD3 bispecific T‑cell engager, has significantly altered the therapeutic landscape of pediatric B‑cell precursor ALL (B-ALL). In relapsed or refractory B‑ALL and in selected frontline settings, randomized studies have shown that blinatumomab can improve clinically meaningful outcome measures and reduce acute-term toxicity when incorporated into chemotherapy backbones. Other applications, including its add-on in infant KMT2A -rearranged B‑ALL and chemotherapy-substitution strategies in newly diagnosed high-risk disease, are highly promising but require careful interpretation due to as-yet small numbers, trial designs, and a lack of mature outcome data. This review integrates the classic principles of pediatric ALL presentation, diagnosis, and treatment with the currently accumulating evidence on blinatumomab, emphasizing both its practice-changing potential and the unresolved questions of MRD surrogacy, resistance, long-term toxicity, cost, and global implementation.
Andishe Attarbaschi (Tue,) studied this question.