During the past decade progress in the treatment of childhood acute lymphoblastic leukemia has slowed. A 50% to 60% cure barrier has frustrated a multitudinous array of therapeutic attempts to overcome this obstacle. With few exceptions, intensifications of induction, consolidation, or maintenance therapies have not overcome this obstacle. Current effort to break through this impasse include improved staging, biological characterization of the leukemia with newer immunodiagnostic methods, and novel approaches to therapy. The latter include continuous intensive therapy in poor prognosis patients and a combination of intensive induction consolidation and delayed intensification.