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UPDATES: NCCN Guidelines® and NCCN Compendium®

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 (ALL). These NCCN Guidelines® are currently available as Version 3.2013.


  • Relapsed/Refractory Ph-positive ALL (ALL-D 3 of 4)
    • Bosutinib added as a treatment optio  for patients with mutations E255K/V, F317L/V/I/C, F359V/C/I, T315A or Y253H.
    • Based on the revised FDA labeling, ponatinib added as a treatment option with the following footnote: “Ponatinib has activity against T315I mutations and is effective in treating patients who have failed multiple TKIs. However, it is associated with a high frequency of serious vascular events (e.g. strokes, heart attacks, tissue ischemia). The FDA indications are for the treatment of adult patients with T315I positive Philadelphia chromosome positive acute lymphoblastic leukemia (Ph+ ALL) and for the treatment of adult patients with Ph+ ALL for whom no other TKI therapy is indicated. For details, see “
    • Dasatinib clarified with the following footnote: “For patients with mutations Y253H, E255K/V or F359V/C/I.”
    • Nilotinib clarified with the following footnote: “For patients with mutations F317L/V/I/C, T315A or V299L.”

*For your reference, the announcement of the previous update (Version 2.2013) to the NCCN Guidelines for ALL,distributed on November 4, 2013, is included below:

NCCN has published updates to the NCCN Guidelines and the NCCN Compendium® for Acute Lymphoblastic Leukemia (ALL). These NCCN Guidelines are currently available as Version 2.2013.

Following the Drug Safety Communication issued October 31, 2013 by the FDA regarding the safety issues with ponatinib (increased frequency of blood clots and narrowing of blood vessels), the agent has been removed as a treatment option for patients with ALL until further discussion by the NCCN ALL Guidelines Panel. 

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