Relapsed or refractory acute lymphoblastic leukemia represents a major challenge in low‐ and middle‐income countries where new therapies are not easily accessible. Combinations of cost‐effective drugs should be considered as a bridge for hematopoietic stem cell transplantation. We retrospectively analyzed pediatric and adolescent and young adult patients who received reinduction with a protocol based on l‐asparaginase, doxorubicin, vincristine, dexamethasone, and bortezomib (BZ). Fifteen patients were included. Total complete response (CR) was achieved by nine of 15 patients (60%); five patients achieved CR with negative minimal residual disease, two achieved complete morphological response (CR), and two complete morphological response without platelet recovery. Eleven patients (73%) were not hospitalized and 10 (66%) did not require any blood component transfusions. There were no cases of serious toxicity or mortality. Nine patients (60%) underwent transplant. Five‐year overall survival was 40%. This BZ‐based protocol is effective and safe when administered as an outpatient regimen and feasible in a low resource setting.
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