NCCN Guidelines for Patients
Acute Lymphoblastic Leukemia, Version 1.2017
Older adults with Ph-positive ALL
TKIs are a type of targeted therapy. TKIs block the
cancer-causing action of the
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.
If you are age 65 or older, or you have other serious
health problems, there are three main options to
choose from. Treatment within a clinical trial is
preferred if one is open and is the right fit for you.
The second option is to have treatment with a TKI
(imatinib or dasatinib) and a steroid. Prednisone and
dexamethasone are the main steroids that may be
used. The third option is to receive a TKI along with a
multiagent chemotherapy regimen.
Steroids may be easier to take than chemotherapy.
Chemotherapy regimens can cause severe side
effects that may be very hard for some patients to
tolerate. If needed, chemotherapy drugs may be
given in lower doses to lessen the side effects.
At the end of induction, your doctor will assess how
well treatment worked. A treatment response is an
outcome or improvement caused by treatment. To
check the response, your doctor will test a sample
of blood and bone marrow with a microscope. A
complete remission is when no leukemia cells are
seen in the blood or bone marrow and all signs and
symptoms of ALL are gone. (See page 37 for more
details about treatment responses.)
If tests show a complete remission, then your doctor
will test for MRD. MRD is when a very small amount
of leukemia cells remains in your body after a course
of treatment. With MRD, the amount of leukemia
cells left is too small to be seen with a microscope.
PCR and flow cytometry are very sensitive tests
that doctors use to check for MRD. These tests
can detect a single leukemia cell among more
than 10,000 normal cells. They can be done on a
sample of blood or bone marrow. But, bone marrow
is preferred. Testing for MRD can help your doctor
decide if more intensive treatments are needed for
If tests show less than a complete remission, this
means treatment wasn’t able to kill enough leukemia
cells in your body. ALL that is not in complete
remission after induction is called refractory ALL. In
this case, treatment with other drugs or regimens will
If induction therapy resulted in a complete remission,
see Guide 9 on page 52 for the next options. If
induction therapy resulted in less than a complete
remission, see Guide 16 on page 65 for the next