**5. Conclusions and future directions**

Treatment of childhood ALL has evolved over the last 50 years with progress made both in the diagnostic and therapeutic arenas. A growing understanding of the biology of the disease has allowed better risk stratification and in some cases alterations to therapy to improve outcomes. Use of pediatric-type protocols in AYA ALL has improved outcomes. Break-through research leading to the development of CAR T-cell therapy, TKIs and monoclonal antibodies have brought a paradigm shift in the management of r/r B ALL. The medical community must now consider the significant cost of these therapies, with questions related to cost-effectiveness and resource allocation ripe for study. Long-term follow-up data for these revolutionary new cancer therapies are required. Outcomes for infant ALL and relapsed T ALL are still dismal and further research is needed to develop newer strategies to combat disease in these group of patients.
