National Comprehensive Cancer Network

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NCCN Flash Update sent June 9, 2014

NCCN has published updates to the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) and the NCCN Drugs & Biologics Compendium (NCCN Compendium®) for Acute Lymphoblastic Leukemia. These NCCN Guidelines are currently available as Version 1.2014.

  • Ph-positive Acute Lymphoblastic Leukemia (ALL) (ALL-4)
    • Consolidation therapy for patients ≥ 65 years of age or patients with substantial comorbidities
      • Footnote added: “Allogeneic HSCT may be considered based on performance status, comorbidities, availability of appropriate transplant donor, and transplant center expertise in treating older patients with allogeneic HSCT.”


  • Typical Immunophenotype by Major ALL Subtypes (ALL-A)
    • The following immunophenotype was added for ETP ALL: “Lack of CD1a and CD8 expression, weak CD5 expression with less that 75% positive blasts, and expression of one or more of the following myeloid or stem cell markers on at least 25% of lymphoblasts: CD117, CD34, HLA-DR, CD13, CD33, CD11b, and/or CD65.”


  • Supportive Care (ALL-B 1 of 4)
    • The following bullet was added: “Methotrexate and Glucarpidase: Consider use of glucarpidase if significant renal dysfunction and methotrexate levels are >10 microM beyond 42–48 h. Leucovorin remains a component in the treatment of methotrexate toxicity and should be continued for at least 2 days following glucarpidase administration. However, be aware that leucovorin is a substrate for glucarpidase, and therefore should not be administered within two hours prior to or following glucarpidase.”


  • Principles of Chemotherapy; Ph-positive ALL (ALL-D 1 of 4)
    • Induction regimens for patients ≥ 40 years of age.
      • Single-agent dasatinib was removed as a treatment option.


  • Maintenance regimens
    • Footnote c modified: “Dose modifications for antimetabolites in maintenance should be consistent with the chosen treatment regimen. It may be necessary to reduce dose/eliminate antimetabolite in the setting of myelosuppression and/or hepatotoxicity.”


  • Minimal Residual Disease (MRD) Assessment (ALL-F)
    • Bullet 2 added: “MRD is an essential component of patient evaluation over the course of sequential therapy. If patient is not treated in an academic center, there are commercially available tests available for MRD assessment.”


  • The Discussion section has been updated to reflect changes in the algorithm. (MS-1)



For the complete updated versions of the NCCN Guidelines, the NCCN Compendium®, and the NCCN Chemotherapy Order Templates (NCCN Templates®), please visit

To access the NCCN Biomarkers Compendium®, please visit

To view the NCCN Guidelines for Patients®, please visit

Free NCCN Guidelines apps iPhone, iPad, and Android devices are now available! Visit