At the molecular level, metformin activates metabolic stress via the AMPK pathway, resulting in the inhibition of several metabolic pathways, such as the mitochondrial respiratory chain and the signaling pathway mediated by nuclear factor kappa B (NF-KB) [19–21] This effect could be beneficial in patients with ALL since it has been demonstrated that NF-KB is responsible for activating the overexpression of ABCB1 genes [22–25] The use of metformin in the pre-induction stage combined with steroids may enhance chemosensitivity and promote the survival of patients with ALL. Here, ABCB1 is linked to acute lymphoblastic leukemia.