Acute lymphoblastic leukemia is common in children and adults over 40 years of age, with a peak incidence age of 4 years and >40 years. In some areas of China, the incidence of acute lymphoblastic leukemia is about 0.69 per 100,000 population. It can be divided into T-cell acute lymphoblastic leukemia and B-cell acute lymphoblastic leukemia by cell source, with T-cell acute lymphoblastic leukemia (T-ALL) accounting for 20% of adult acute lymphoblastic leukemia. T-ALL has been classified as a high-risk acute lymphoblastic leukemia due to its poor response to conventional chemotherapy, susceptibility to early onset of cerebral white, and refractory relapse status. In recent years, with the improvement of chemotherapy regimens for children with acute gonorrhea, including the increase of chemotherapy drug doses, the rational combination of chemotherapy drugs, and the strengthening of supportive therapy, especially the emphasis on the consolidation of intensive therapy after remission, the treatment effect of children with ALL has been significantly improved, with 5-year event-free survival reaching 83-85%; however, the efficacy in adults is still unsatisfactory, only 35-40%. (i) Prognostic factors: Traditionally high age, high leukocytes, Pro-B and T-cell phenotypes, Ph chromosomes and low diploidy are all manifestations of high-risk acute gonorrhea, but with the use of high-dose intensive therapy and protocol optimization leukocyte count is no longer a factor affecting prognosis, and acute gonorrhea has achieved more than 80% long-term survival. Common chromosomal abnormalities in T-ALL, mostly involving TCR rearrangements, have no significant prognostic impact in pediatric patients treated with intensive regimens; however, HOX-11L2 and SIL-TAL1 expression in adult T-ALL patients treated with adult regimens suggest poor prognosis. high expression of the ETS transcription factor ERG is also a factor in poor prognosis in adult acute gonorrhea. CpG island methylation is a common epigenetic abnormality in various hematologic tumors. 88% of T-ALL patients have at least one gene methylation, and it was found that the 12-year disease-free survival rate of T-ALL patients with 0-2 gene methylations was 100%, while only 20% of patients with >2 gene methylations. Drug resistance is an important prognostic factor. High expression of multidrug resistance-associated protein-3 (MDP3) suggests a poor prognosis for ALL. The 5-year disease-free survival was only 47% for those who did not remit in one course of BFM-90 and 95 chemotherapy, which were judged as high-risk ALL. The prognosis is determined by the choice of treatment regimen, and the long-term disease-free survival rate is higher with the pediatric acute gonorrhea regimen. nearly 80% of patients treated with the pediatric acute gonorrhea regimen at DFCI are disease-free in the long term, compared to less than 40% with the adult regimen. (ii) Chemotherapy: 5-year disease-free survival is >80% in pediatric patients treated with chemotherapy alone. Although adults with acute lymphoblastic leukemia have a complete remission (CR) rate of 75-93% after induction therapy with a combination chemotherapy regimen consisting of conventional VP regimen + anthracycline, levomenthase, or cyclophosphamide, the long-term survival rate is only 35-40%, with most patients relapsing during subsequent maintenance therapy. How to improve the long-term survival rate of adults with acute gonorrhea is currently a clinical challenge. Chemotherapy for acute gonorrhea is divided into induction therapy and post-remission therapy, and post-remission therapy usually consists of intensive therapy and maintenance therapy. Sebban et al. prospectively compared the prognostic impact of changes in myelogram on day 15 of induction therapy, with a 5-year DFS of 34% in patients with <5% of primary young gonorrhea and only 19% in those with >5%, although all patients achieved CR at 4 weeks. day7 response to hormones also affects prognosis. There is no doubt that achieving complete remission as early as possible in the induction phase of chemotherapy is one of the most important treatment goals for ALL today. The most common drugs used in remission induction regimens include prednisone, vincristine, anthracyclines, and other drugs. Vincristine, anthracyclines (mostly erythromycin), and levomepromazine; they are also combined with cyclophosphamide, cytarabine (regular or high dose), 6-mercaptopurine, or other drugs for early intensive therapy. The high concentration of dexamethasone in the cerebrospinal fluid and its strong anti-leukemic effect have led to its replacement of prednisone in many regimens, and the MRC ALL97/99 results showed a significantly lower rate of CNS leukemia recurrence with a 3-year DFS of 87% vs. 79% for dexamethasone compared with prednisolone. L-ASP is the most commonly used drug in pediatric acute gonorrhea regimens and affects tumor protein synthesis by hydrolyzing depletion of serum menadione; sustained menadione depletion is critical for treatment success, and the ability of leukemic cells to synthesize menadione is a factor affecting L-ASP in addition to drug concentration and duration. Compared to B-ALL, T-ALL cells have a higher expression of portal synthetase, and in addition patients with mesenchymal cells express 20 times more portal synthetase than leukemic cells, which protects leukemic cells from killing and must sustain sufficient L-ASP and meet PK/PD requirements. Clinical trials have shown that E. coli-derived L-ASP is significantly more efficacious than equivalent doses of Erwinia-derived L-ASP, and that long-acting (PEG-ASP) dosage forms are superior to conventional dosage forms. High-dose L-ASP significantly improved the prognosis of acute gonorrhea in children, and in several large clinical trials, post-remission regimens with repeated reinforcement with high-dose L-ASP were superior to regimens without L-ASP, and multifactorial analysis of the results of randomized clinical trials showed that the absence of reinforcement with L-ASP was a significant adverse prognostic factor in children at risk for acute gonorrhea.