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NCCN Guidelines for Patients



Acute Lymphoblastic Leukemia, Version 1.2017


Treatment guide

AYAs with Ph-negative ALL

AYAs with Ph-negative ALL

Guide 10

shows the induction therapy options for

AYAs with Ph-negative 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 usually consists of high doses of

chemotherapy drugs. It is very intensive and lasts

about four weeks (one month). You may need to stay

in the hospital for some or all of the time during this


Induction therapy options

In general, there are three main options to choose

from for induction therapy. Treatment within a clinical

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

you. The other options are to receive multiagent

chemotherapy outside of a clinical trial.

A regimen based on treatment designed for children

with ALL may be selected. This is called a pediatric-

inspired regimen or a pediatric-inspired protocol. But,

other multiagent chemotherapy regimens that have

been studied in AYAs may also be used.

Induction regimens tend to use a combination of

vincristine, pegaspargase, a steroid (prednisone or

dexamethasone), and an anthracycline (doxorubicin

or daunorubicin). Some regimens may also include

cyclophosphamide, etoposide, or (for CD20-positive

disease) rituximab.

Pediatric-inspired regimens often start CNS

preventive treatment very early at the start of 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.

Guide 10. Remission induction for AYAs with Ph-negative ALL

Induction therapy options


Next options

Clinical trial



chemotherapy regimen



chemotherapy regimen



• Complete



• Monitor for MRD

• Less than



• Treatment for relapsed/refractory ALL