OBJECTIVES:  We conducted a retrospective chart review to quantify the time and reimbursement associated with hospitalizations for ALL salvage chemotherapy in a Spanish hospital. METHODS:  Eligibility criteria were: aged ≥18 years and hospitalized from 1998-2014 to receive treatment for Ph-negative R/R ALL (relapsed with first remission lasting <12 months, relapsed after first salvage therapy, relapsed any time after hematopoietic stem cell transplant [HSCT], or refractory to initial or salvage therapy). Data were collected from the index date (first diagnosis of R/R ALL) until death or loss to follow-up. The chemotherapy period was defined as the first chemotherapy hospitalization after the index date to the earliest of HSCT, death, loss to follow-up, or last chemotherapy dose plus 30 days. The primary endpoint was the percentage of time hospitalized during the chemotherapy period. Reimbursement associated with hospitalizations was determined. RESULTS:  Thirty-two patients were eligible and 31 received intensive salvage chemotherapy. Half (n=16, 50%) had first remission duration ≤12 months, 11 (34%) had prior HSCT, 4 (13%) were refractory and 1 (3%) relapsed after first salvage. The median age was 41 years and 34% were male. During the chemotherapy period there were 42 inpatient hospitalizations (mean 1.4 per patient) with a mean duration of 26 days. Patients spent a mean of 71% of the chemotherapy period in hospital; mean reimbursement was €18,986 per inpatient hospitalization and €26,417 per patient. From the index date to death (excluding HSCT) there were 80 inpatient hospitalizations with a mean duration of 24 days; mean reimbursement was €16,692 per hospitalization and €43,753 per patient. Eight patients received a HSCT, resulting in 18 hospitalizations, associated with mean reimbursement of €39,782 per inpatient hospitalization and €95,519 per patient. CONCLUSIONS: Salvage chemotherapy for adult patients with Ph-negative R/R ALL is associated with extensive hospitalization and high economic cost in Spain.