Acute Lymphoblastic Leukemia (ALL) represents approximately 75% of childhood leukemia cases, with survival rates now exceeding 90% in high-income countries due to therapeutic advances. This review evaluates recent improvements in chemotherapy protocols, focusing on comparative efficacy between traditional regimens and novel approaches incorporating targeted therapies and immunotherapies.

To analyze survival outcomes, treatment efficacy, and cost-effectiveness of contemporary chemotherapy protocols for pediatric ALL, with emphasis on emerging therapeutic strategies.

An integrative literature review was performed following the PICCO framework. Searches in PubMed and Cochrane databases employed Boolean operators, limited to studies published within the last five years. Selection criteria included clinical trials and systematic reviews addressing pediatric ALL treatment in hospital settings, while excluding diagnostic or prophylactic studies. After PRISMA-guided screening and duplicate removal, 13 studies met inclusion criteria.

The analysis revealed significant progress in treatment protocols. The ALL-B12 regimen demonstrated superior survival rates (≥90%) through intensified chemotherapy combining pulsed vincristine/dexamethasone with high-dose methotrexate and PEG-asparaginase, while showing reduced toxicity compared to conventional asparaginase. Immunotherapies exhibited remarkable outcomes, particularly in high-risk and relapsed cases. Blinatumomab improved survival rates while proving more cost-effective than standard chemotherapy. CAR-T cell therapy (tisagenlecleucel) achieved durable remission in refractory cases, and inotuzumab ozogamicin showed high response rates in relapsed B-cell ALL. The combination of venetoclax with chemotherapy enhanced survival in relapsed AML. Despite these advances, higher costs and infrastructure requirements for novel therapies pose challenges for implementation in resource-limited settings, highlighting disparities in global accessibility.

Contemporary treatment protocols integrating chemotherapy with immunotherapy and targeted agents have transformed pediatric ALL management, particularly for high-risk cases. While therapeutic innovations show promising efficacy and safety profiles, equitable access remains a critical challenge. Future research should address cost barriers and optimize implementation strategies to ensure global benefit.