Main outcome results. (A) OS: median was not reached; 3-year rate, 66.7% (95% CI, 60-74); (B) EFS: median was not reached; 3-year rate, 58% (95% CI, 51-65); (C) DFS, representing the primary study objective compared with prior GIMEMA study LAL 0904: median was not reached; 2-year rate, 70% (95% CI, 63-77) vs 45% (95% CI, 39-51); and 3-year rate, 63% (95% CI, 56-71) vs 38% (95% CI, 38-44), P < .0001; (D) 3-year DFS per ITT risk-oriented therapy: chemotherapy, 74% (95% CI. 65-83), allogeneic HCT, 50% (95% CI, 39-63), P = .0022; (E) 3-year DFS in the ITT allogeneic HCT group per time-dependent HCT realization: HCT, 75% (95% CI, 55-89) vs no HCT, 26% (95% CI, 15-45), P < .0001; (F) Cumulative incidence of TRM during induction (ID) and CR, and of resistance/relapse (Res/Rel) based on B- or T-ALL/LL diagnosis: 3-year incidence ID/CR death B-ALL/LL, 17.8% (95% CI, 11.3-24.3) vs T-ALL/LL, 4.8% (95% CI, 0-10.1), P = .0127; Res/Rel B-ALL/LL, 28.7% (95% CI, 20.9-36.6) vs T-ALL/LL, 28.1% (95% CI, 16-40.4), P = .773.