NCCN recently released the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for Pediatric Acute Lymphoblastic Leukemia (ALL)-the most comprehensive and up-to-date evidence-based, consensus-driven guidelines for treating children with cancer outside of a clinical trial setting. These new NCCN Guidelines are the first of several planned to address pediatric cancers. "We are publishing the NCCN Guidelines for Pediatric ALL in response to a growing global need for protocols that

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... e children with cancer receive the best care possible, no matter where they're treated," said Robert W. Carlson, MD, Chief Executive Officer, NCCN. "Thankfully, in recent years pediatric ALL has reached a very high cure rate, with almost all low-risk patients achieving long-term survival. However, that means fewer patients are being treated within the context of a clinical trial, which creates the need for treatment guidelines that set sufficient and appropriate standards for care. NCCN's evidence-and expertconsensus-based approach, proven track record for improving outcomes, and ability to provide rapid updates, allows us to fill this void." ALL is a blood cancer that impacts about 2,900 people aged #21 years in the United States every year. It is the most common children's cancer, accounting for 35% of all cancers in that age group. 1 Treatment typically involves multiagent chemotherapy regimens, lasts for 2 to 3 years, and comprises 4 components: remission induction, consolidation, maintenance, and central nervous systemdirected therapy. 2 Pediatric ALL is also at the forefront for innovative new approaches such as targeted therapy and immunotherapy, including the first FDA approval for CAR T-cell therapy. 3 "The cure rate for pediatric ALL in the U.S. has risen from 0% in the 1960s to nearly 90% today," said Patrick Brown, MD, Associate Professor of Oncology and Pediatrics, Director, Pediatric Leukemia Program, The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Chair, NCCN Guidelines for Adult and Pediatric ALL. "This is among the most profound medical success stories in history. The NCCN Guidelines assemble today's 'best practices' into one comprehensive, consensus document, based on input from experts across medical disciplines, including pediatric oncologists, radiation oncologists, bone marrow transplant physicians, infectious disease experts, and molecular pathologists." "These guidelines ensure that every child gets the highest quality treatment, even outside of a clinical trial," said Hiroto Inaba, MD, PhD, Member, St. Jude Children's Research Hospital, Vice Chair, NCCN Guidelines for Pediatric ALL. "Our recommendations include a strong focus on supportive care, so hopefully patients will not experience severe side effects. Pediatric ALL survivors live a long time; we have to consider long-term effects as well." The NCCN Guidelines for Pediatric ALL span birth through adolescence and into young adulthood. They were designed to overlap with the NCCN Guidelines for Adult ALL, and harmonize treatment approaches for patients in the overlapping age rage. The recommendations are categorized by risk level, which can also be age-related; with the highest risk associated with those diagnosed within the first 12 months of life or between age 10 and 21 years. "One unique and useful component of these guidelines is the identification of vulnerable populations, and assembling the best supportive care advice for Cont. on page xxxviii.