Complex interplay between inpatient vs outpatient care and local vs referral medical systems that makes up the current management of adults with ALL. When these patients come to medical attention, they can do so via different entry points. An initial evaluation typically identifies some suspicious findings. From here, many are referred to larger centers with expertise in managing this diagnosis. However, this is not the case for all, particularly if getting to the referral center is prohibitively difficult for logistical or financial reasons; in these cases, patients will often remain at their local hospital, as long as this facility can provide the required level of care. Treatment for ALL typically starts within days of the initial diagnosis and virtually always on an inpatient basis. After a period of inpatient observation, patients who are medically stable may discharge with close outpatient follow-up, provided this center is able to deliver the necessary ongoing care. Otherwise, they may require a longer period of inpatient monitoring to ensure they have consistent access to critical supportive care such as transfusions and any ongoing treatment their regimen includes, etc. Then, depending on the specific approach being used and social factors, management may require repeated hospitalization, continued treatment as an outpatient, and/or referral back to a local facility. Dashed lines are meant to represent transitions in the location of care delivery (eg, inpatient to outpatient). Heme/Onc, hematology/oncology; PCP, primary care provider. Figure created using biorender.com. Cassaday R.D. (2025) https://biorender.com/05k7ae9.