Optimal patient management strategies for adults with BL require a careful evaluation of prognostic factors. The primary barriers to achieving disease control and long-term survival are primary refractory disease, early toxic deaths related to therapy, and the risk of late toxicities. Overemphasis of a single factor can unfavorably tip this delicate balance. The factors that require careful consideration are a combination of patient-related factors (age, performance status), biology-related factors (CNS disease, LDH level), and the resources available for prompt implementation of intensive supportive care.