What is relapsed or refractory acute lymphoblastic leukemia (ALL)?

Relapsed ALL

You achieved remission with your previous cancer treatment, but your ALL has returned.

Refractory ALL

Your ALL did not respond to the previous cancer treatment.

What are the goals of treatment in relapsed or refractory ALL?
  • While the goals of treatment can differ for each patient, the primary goal of treatment in relapsed or refractory ALL is to achieve remission
  • Some patients also hope to receive stem cell transplant, which offers a chance for cure in ALL
What are the treatment options for relapsed or refractory ALL?

The treatment landscape is evolving in ALL, and new therapies continue to become available. Your doctor will decide which treatment option is best for you. These may include:


You were likely prescribed chemotherapy as part of your initial ALL treatment regimen. Chemotherapy refers to a variety of drugs that damage or kill cells throughout the body.

Targeted therapies

Several different therapies are available that target specific proteins on ALL cells, such as CD19, CD22, and CD20.

Stem cell transplant

A procedure that replaces the blood-forming stem cells in your bone marrow with healthy cells, restoring normal blood cell growth.

CAR T-cell therapy

A gene therapy that can help your immune system to better recognize and fight your cancer, used in patients whose ALL is refractory to their prior treatment or who have relapsed multiple times.

Clinical trials

Clinical trials study whether an investigational therapy may offer a benefit to patients.



BESPONSA can cause liver problems that can be severe, life-threatening, or fatal, including a condition called veno-occlusive disease (VOD). This condition can occur during treatment with BESPONSA or following subsequent treatment with a stem cell transplant. This condition was more common in patients who had elevated liver tests or who received dual alkylating agents in preparation for their stem cell transplant. Patients may be at a higher risk of VOD if they:

  • Receive a stem cell transplant after treatment with BESPONSA
  • Have previously received a stem cell transplant
  • Have ongoing or a history of liver problems
  • Are of older age
  • Received multiple treatments for their ALL prior to BESPONSA
  • Receive a greater number of BESPONSA treatment cycles

Your doctor should perform liver tests periodically during treatment, and may modify or stop your treatment with BESPONSA.

Tell your doctor about all of the medicines you take, including prescription and over-the-counter medicines, vitamins, and herbal supplements.

BESPONSA may cause serious side effects, including:

  • Liver problems: Call your doctor right away if you experience rapid weight gain, yellowing of the whites of the eyes, or abdominal swelling that may be painful. The risk of developing VOD is increased after receiving treatment with BESPONSA. Discuss with your doctor the benefit/risk of BESPONSA treatment if you have a prior history of VOD or serious ongoing liver disease
  • Increased risk of death after stem cell transplant: Call your doctor right away if you experience any signs and symptoms of infection or liver problems. There is an increased risk of death due to infection and VOD after receiving BESPONSA
  • Low blood cell counts: Low blood cell counts and complications of low blood cell counts, including bleeding and infections, which may be severe, life-threatening, and fatal, have occurred with BESPONSA. Call your doctor right away if you experience signs and symptoms of infection (for example, redness, swelling), unexpected bleeding or bruising, blood in your urine or stools, or fever
  • Infusion-related reactions: Inform your doctor right away if you experience fever, chills, rash, or breathing problems during or following your BESPONSA infusion
  • Heart problems: Call your doctor right away if you feel dizzy, lightheaded, or faint or have very slow, very fast, or abnormal heartbeats. Tell your doctor about all the medicines you take

Before taking BESPONSA, tell your doctor about all of your medical conditions, including if you:

  • Have liver disease or a history of liver problems
  • Have an infection
  • Have ever experienced symptoms such as fever, chills, rash, or breathing problems during or shortly after your BESPONSA infusion
  • Have heart problems, including an event of QT prolongation
  • Are pregnant, plan to become pregnant, or if pregnancy is suspected while taking BESPONSA. Avoid becoming pregnant during treatment with BESPONSA. BESPONSA can cause harm to an unborn baby
    • Females who are able to become pregnant should use effective contraception during treatment with BESPONSA and for at least 8 months after the last dose
    • Males of reproductive potential should use effective contraception during treatment with BESPONSA and for at least 5 months after the last dose
  • Are breastfeeding or plan to breastfeed. Avoid breastfeeding during treatment with BESPONSA and for at least 2 months after the final dose

Common Side Effects of BESPONSA

The most common side effects are low platelet counts (thrombocytopenia), low white blood cell counts with and without fever (neutropenia, febrile neutropenia, and leukopenia), infection, low red blood cell counts (anemia), fatigue, bleeding, fever, nausea, headache, increases in lab tests measuring liver function, and pain in the abdomen.

These are not all of the possible side effects of BESPONSA. Tell your doctor if you have any side effect that bothers you or that does not go away. For more information, ask your doctor or pharmacist.


BESPONSA® (inotuzumab ozogamicin) is a prescription medicine used to treat adults with relapsed or refractory B-cell acute lymphoblastic leukemia (ALL). It is not known if BESPONSA is safe and effective in children under 18 years of age.

Please see Full Prescribing Information, including BOXED WARNING.