How would you manage a pediatric patient with hypodiploid acute lymphoblastic leukemia?

There is some evidence that patients with hypodiploid ALL do not benefit from HSCT (Pui et al., JCO 2019, McNeer et al., JCO 2019), but it is important to keep in mind that these two studies were retrospective.

Assuming this is frontline, I would enroll them on a COG protocol, AALL1731 or AALL1732 deepening on presentation. Of note, screen for Li–Fraumeni syndrome.