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NCCN Guidelines for Patients



Acute Lymphoblastic Leukemia, Version 1.2017


Treatment guide

AYAs with Ph-positive ALL

Chemotherapy drugs are given in higher (intensified)

doses during consolidation. CNS preventive

treatment is also usually given throughout this phase

of treatment. Consolidation therapy may last several

months. How long it lasts and the total number of

cycles varies based on the regimen used. The full

treatment regimen should be followed all the way

through consolidation and to the end of maintenance.

Maintenance therapy options

The third phase of ALL treatment is called

maintenance. This phase is started after you finish

consolidation therapy. Maintenance therapy is

given to keep up (maintain) the good results of prior

treatments. The goal is to prevent a relapse after

induction and consolidation therapy. A relapse is

when leukemia cells come back after a complete


Staying on treatment with a TKI is a key part of

maintenance therapy. Most maintenance regimens

include weekly methotrexate and daily 6-MP.

Often, monthly pulses of vincristine and a steroid

(prednisone or dexamethasone) are also given for 2

to 3 years. A TKI such as imatinib, dasatinib, nilotinib,

or ponatinib should be added to the maintenance

regimen your doctor plans for you.

Staying on treatment with a TKI is a key part of

maintenance therapy. If you are not treated with an

allogeneic SCT, you will likely receive a TKI together

with a maintenance chemotherapy regimen for 2 to 3


Maintenance therapy drugs are often given in

lower doses and cause fewer side effects. CNS

preventive treatment can also be given throughout

this treatment phase. This regimen may include

weekly methotrexate, daily 6-MP, monthly vincristine,

and a steroid (prednisone or dexamethasone).

Methotrexate and 6-MP can affect the liver or lead

to low blood counts, and may require dose reduction

or discontinuation when treating together with a TKI.

Your doctor will typically continue the same TKI used

during your earlier phases of therapy, as long as you

are tolerating and responding well to it.

If you are treated with an allogeneic SCT,

maintenance therapy with a TKI may be

recommended. In this situation, the TKI is most

commonly given without other chemotherapy

medicines. It is usually given for at least one year but

doctors are not completely sure how long it should


At this point of care, your doctor will consider MRD

testing on a regular basis if you have a complete

remission. This testing may happen at least every

3 months. Testing may occur more often if MRD is


Next steps

After completing consolidation and maintenance

therapy, see Guide 15 on page 63 for follow-up