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NCCN Guidelines for Patients



Acute Lymphoblastic Leukemia, Version 1.2017


Treatment guide

Older adults with Ph-positive ALL

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.

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

consolidation therapy.

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

be tried.

Next steps

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