NCCN Guidelines for Patients
Acute Lymphoblastic Leukemia, Version 1.2017
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
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
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
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
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. 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
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.