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48

NCCN Guidelines for Patients

®

:

Acute Lymphoblastic Leukemia, Version 1.2017

5

Treatment guide

AYAs with Ph-positive ALL

Guide 7. Postremission consolidation and maintenance

Consolidation therapy options Maintenance therapy options

Allogeneic SCT if a donor is

available

or

If an allogeneic SCT donor is not

available,

continue multiagent

chemotherapy regimen + TKI

• Consider post-SCT TKI

ª

• TKI, and

• Maintenance therapy with:

• Monthly vincristine/prednisone pulses

• Weekly methotrexate

• Daily 6-MP

ª

Guide 7

shows the treatment options for AYAs with

Ph-positive ALL in complete remission after induction

therapy. Consolidation therapy is the second phase

of treatment for ALL. The goal of this phase is to kill

any leukemia cells that may still be in your body. It is

followed by maintenance therapy. These phases are

jointly referred to as postremission therapy since they

are given after ALL is in remission.

Your doctor will look at many factors to help plan

consolidation therapy. This includes the ALL cell

subtype, chromosome changes, results of MRD

testing, and other prognostic factors. Your general

health, current symptoms, and side effects will

also be noted. This can help to decide if you need

and can tolerate more intensive treatment for

consolidation.

Consolidation therapy options

There are two main options for consolidation therapy.

The first option is to have an allogeneic SCT. This

option is recommended if a well-matched donor

has been found. Consolidation with an allogeneic

SCT may help keep ALL from coming back after a

complete remission.

But, it is a very intensive treatment and may not be a

good choice for everyone.

Your doctor will look at a number of factors to decide

if an allogeneic SCT is a good choice for you. This

includes your age, prognostic factors, and how well

prior treatments worked. For some AYA patients, an

allogeneic SCT may offer the best chance of a long-

lasting remission. For other patients, an allogeneic

SCT might not be better than chemotherapy and a

TKI.

The second option is to stay on multiagent

chemotherapy combined with a TKI. This option is

suggested if a well-matched donor for the SCT has

not been found. This may also be a good option if

your doctor thinks an allogeneic SCT is too intense

for you.

Consolidation therapy may include combinations

of drugs similar to those used for induction. A

TKI should be added to the consolidation therapy

regimen for all patients with Ph-positive ALL.

Imatinib, dasatinib, nilotinib, and ponatinib are TKIs

used for this phase. Staying on treatment with a

TKI can help keep ALL from coming back after a

complete remission.