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NCCN Guidelines for Patients



Acute Lymphoblastic Leukemia, Version 1.2017


Treatment guide

AYAs with Ph-positive ALL

AYAs with Ph-positive ALL

Guide 6. Remission induction for AYAs with Ph-positive ALL

Induction therapy options Response Next options

Clinical trial



chemotherapy regimen



TKI + corticosteriods


Complete remission


Monitor for MRD


Less than complete



Treatment for

relapsed/refractory ALL

Guide 6

shows the induction therapy options for

AYAs with Ph-positive ALL. Induction therapy is

the first phase of treatment for ALL. It is also called

remission induction. The goal is to kill all of the

leukemia cells in your bone marrow and put ALL into

complete remission.

Induction therapy usually consists of high doses of

chemotherapy drugs. It is very intensive and lasts

about four weeks (one month). You may need to stay

in the hospital for some or all of the time during this


Induction therapy options

In general, there are a few options to choose from

for induction therapy. Treatment within a clinical trial

is preferred if one is open and is the right fit for you.

Other options include a multiagent chemotherapy

regimen or a corticosteroid (prednisone or

dexamethasone), both combined with a TKI.

TKIs are a type of targeted therapy. TKIs block the

cancer-causing action of the


fusion gene.

This gene is found on the Philadelphia chromosome.

The use of TKIs has greatly improved treatment

outcomes for Ph-positive ALL. Importantly, adding

a TKI to the multiagent chemotherapy regimen

increases the chance of a complete remission.

Imatinib, dasatinib, ponatinib, or nilotinib are the TKIs

used for induction therapy.

Induction regimens for AYAs generally include

a combination of vincristine, pegaspargase, a

steroid (prednisone or dexamethasone), and an

anthracycline (doxorubicin or daunorubicin). Some

regimens may also include cyclophosphamide.

CNS preventive treatment is given to all patients

during the induction phase. For CNS treatment,

drugs are often injected into the spinal fluid during a

lumbar puncture. When drugs are given this way, it is

called IT therapy or IT chemotherapy.

CNS treatment may include IT methotrexate alone

or with other drugs such as IT cytarabine and an IT

steroid (prednisone or dexamethasone). When all

three drugs are given, it is called triple IT therapy.

Methotrexate, cytarabine, and 6-MP may also be

given as IV injections for CNS treatment. Rarely,

CNS disease may be found when ALL is first

diagnosed. In this case, your doctor may consider

giving cranial irradiation as well.