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NCCN Guidelines for Patients



Acute Lymphoblastic Leukemia, Version 1.2017


Cancer treatments

Targeted therapy

Side effects of TKIs

Some side effects listed below are caused by only

one TKI. Others are caused by all or most TKIs but

differ in how likely they are to occur. Some common

side effects of TKIs are low blood cell counts,

abnormal bleeding, fatigue, nausea and vomiting,

diarrhea, and stomach or belly pain.

These drugs may cause swelling due to fluid buildup

around the eyes or in the hands and feet. Fluid may

also collect around the lungs. Other common side

effects include skin rashes, headaches, and muscle,

bone, and joint pain. A rare but serious side effect

that may happen with TKIs is a change in the rhythm

of your heartbeat.

Other rare but serious side effects may be caused by

certain TKIs. For example, dasatinib may cause fluid

buildup around the lungs. Nilotinib may cause the

amount of sugar (glucose) in the blood to be higher

than normal. Serious side effects of ponatinib include

heart problems, blood clots, narrowing of blood

vessels, heart attack, and stroke. Liver problems or

inflammation of the pancreas may also happen.

Monoclonal antibodies

Monoclonal antibodies are another type of targeted

therapy used for ALL. A monoclonal antibody is a

type of immune system protein that is made in a lab.

Monoclonal antibodies attach (bind) to proteins on

cancer cells. Most monoclonal antibodies can bind to

only one protein.


Blinatumomab is one of the newer treatments for

ALL. It is a monoclonal antibody that may be used for

certain patients with B-cell ALL after other treatments

didn’t work well.

Blinatumomab is a special kind of antibody that can

bind to two proteins at the same time. It binds to a

protein called CD19 that is found on immature B-cells

and some leukemia cells. It also binds to a protein

called CD3 that is found on normal T-cells. T-cells

are part of the body’s immune system. By binding to

these two proteins, blinatumomab links the T-cells

to the leukemia cells. This helps the immune system

find and kill the leukemia cells.

Blinatumomab is a liquid that is slowly injected into

a vein over 28 days. This is called a continuous

infusion. Blinatumomab should only be given in a

cancer center that has experience with this drug. You

may need to stay in the hospital for the first few days

of treatment.

Side effects of this drug are fever, skin rash, nausea,

diarrhea, constipation, swelling of the hands and feet,

headache, and shaking (tremor). It can also cause

low white blood cell counts, which increases the risk

of infection.

Though uncommon, a severe reaction during

the infusion may happen. This can cause trouble

breathing, headache, feeling dizzy or lightheaded,

low blood pressure, fever, chills, and face swelling.

Other less common but serious side effects are

seizures, trouble speaking or slurred speech, passing

out, confusion, and loss of balance.


Rituximab is a monoclonal antibody that may be

used to treat certain patients with B-cell ALL. It binds

to a protein called CD20. This protein is found on

the surface of normal and abnormal B-cells. And, it

is found on the leukemia cells of about half of adults

with B-cell ALL.

When rituximab binds to CD20, it sends a signal to

the cell to die. It also marks the cells for destruction

by the immune system. Rituximab is not used alone

to treat ALL. Instead, it is added to a chemotherapy

combination regimen. It is given as a liquid that is

slowly injected into a vein.