OBJECTIVES: Acute lymphoblastic leukemia (ALL) is the most common malignant disease in pediatric patients, but is rare in adults. Thus, many adult treatment regimens and costing analyses are based on, or adapted from, pediatric protocols. This analysis aims to capture the costs of standard of care treatment regimens for adults who receive front-line therapy for Philadelphia chromosome-negative B-cell precursor ALL. METHODS: In Canada, HyperCVAD and Dana Farber Cancer Institute (DFCI) protocols represent the current standard of care regimens for adult ALL patients. This analysis collected drug, administration, physician services, laboratory tests and hospitalization costs. Resource use and costs were informed by published protocols, expert clinician experience, QuintilesIMS DeltaPA, Ontario Case Costing Initiative and Ontario fee schedules. Costs were reported by treatment phase of each regimen. Uncertainty was explored through probabilistic and deterministic sensitivity analyses. RESULTS: The complete HyperCVAD and DFCI protocols are estimated to cost $51,863 and $35,036, respectively. Drug costs accounted for 18% of total costs in the HyperCVAD regimen as compared to 46% in the DFCI regimen; the remaining costs were driven by hospitalization ($31,965 vs. $13,770, respectively). Results were robust to the probabilistic sensitivity analysis. CONCLUSIONS: By using current cost data and recently modified chemotherapy regimens, this analysis represents the most up to date estimation of the cost of treating adult ALL patients. Both HyperCVAD and DFCI protocols pose considerable financial burden; the DFCI treatment protocol is estimated to cost the healthcare system more in drug costs but substantially less in hospitalization costs compared to the HyperCVAD protocol.