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53

NCCN Guidelines for Patients

®

:

Acute Lymphoblastic Leukemia, Version 1.2017

5

Treatment guide

Older adults with Ph-positive ALL

For some patients, an allogeneic SCT may offer the

best chance of a long-lasting remission.

The second option is to stay on the multiagent

chemotherapy regimen and 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 the

TKIs used for this phase. Staying on treatment with

a TKI can help keep ALL from coming back after a

complete remission.

Often, chemotherapy drugs are given in higher

(intensified) doses during consolidation. CNS

preventive treatment can also be 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.

If you are age 65 or older, or you have other serious

health problems, there are two main options to

choose from. A key part of both options is to continue

treatment with a TKI. Imatinib, dasatinib, nilotinib,

and ponatinib are the TKIs that may be used. The

first option is to keep taking the TKI with or without

steroids such as prednisone or dexamethasone.

The second option is to keep taking the TKI with or

without chemotherapy.

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

remission.

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. A

TKI such as imatinib, dasatinib, nilotinib, or ponatinib

should be added to the maintenance regimen your

doctor plans for you.

After consolidation with an allogeneic SCT,

maintenance therapy with a TKI is often

recommended. The TKI may be given alone. Or,

other drugs may also be given if side effects aren’t

too severe.

Methotrexate and 6-MP can affect the liver and

lower the bone marrow’s ability to make new blood

cells. These side effects can be severe and hard to

tolerate. If needed, lower doses of these drugs may

be given to lessen the side effects.

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. Maintenance therapy is given for

about two to three years. But, the total length varies

based on the regimen used. Adult regimens tend to

give maintenance therapy for a shorter amount of

time than pediatric-inspired regimens.

Your doctor will consider MRD testing on a regular

basis for if you have a complete remission. This

testing may happen at least every 3 months. Testing

may occur more often if MRD is detected.