Jeha S, Pei D, Choi J, et al. - Since relapse has been reported in up to 10% of children with acute lymphoblastic leukemia despite contemporary treatment, researchers determined if an improved systemic and CNS control could be achieved by a higher dosage of PEG-asparaginase and early intensification of triple intrathecal therapy. Randomly, PEG-asparaginase 3,500 U/m² vs the conventional 2,500 U/m² was administered to 598 consecutive patients (age 0 to 18 years) who were given risk-directed chemotherapy without prophylactic cranial irradiation in the St Jude Total Therapy Study 16 between 2007 and 2017. During the first 2 weeks of remission induction, two extra doses of intrathecal therapy were administered to patients having features related to increased risk of CNS relapse. No improvement in outcome was brought about by administering higher doses of PEG-asparaginase, but a possible contribution of additional intrathecal therapy, during early induction, to improved CNS control was suggested with no report of excessive toxicity for high-risk patients.