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50

NCCN Guidelines for Patients

®

:

Acute Lymphoblastic Leukemia, Version 1.2017

5

Treatment guide

Older adults with Ph-positive ALL

Older adults with Ph-positive ALL

Guide 8. Remission induction for older adults with Ph-positive ALL

Health status Induction therapy options Response

Patients <65 years

of age without

serious health

problems

ª

• Clinical trial

• Multiagent

chemotherapy

regimen + TKI

ª

• Complete remission, monitor for MRD

ª

• Less than complete remission, start

treatment for relapsed/refractory ALL

Patients ≥65 years

of age or with other

serious health

problems

ª

• Clinical trial

• TKI +

corticosteroids

• TKI +

chemotherapy

ª

• Complete remission, monitor for MRD

ª

• Less than complete remission, start

treatment for relapsed/refractory ALL

Guide 8

shows the induction therapy options for

older adults 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 may consist of high doses of

chemotherapy drugs. It is very intensive and lasts

about four weeks. You may need to stay in the

hospital some or all of the time during this treatment.

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 (dexamethasone or prednisone). 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.

Induction therapy options

Often, age 65 is the cut-off for intensive treatment.

But, age alone is not a good gauge of a person’s

overall health or fitness for intensive treatment. When

choosing an induction regimen, your doctors will

look at your age, general health, organ function, and

other current health conditions. This will help your

doctor to know if you are able to receive very strong

treatments.

If you are younger than age 65, or you don’t have

other serious health problems, there are two main

options to choose from. Treatment within a clinical

trial is preferred if one is open and is the right fit

for you. The other option is to have a multiagent

chemotherapy regimen combined with a TKI. The

TKIs used for induction therapy include imatinib,

dasatinib, nilotinib, and ponatinib.