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NCCN Guidelines for Patients



Acute Lymphoblastic Leukemia, Version 1.2017


Treatment guide

AYAs with Ph-negative ALL

Response and next options

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.

If tests show a complete remission, then your doctor

may 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. Bone marrow is usually

preferred. Testing for MRD can help your doctor

decide if more intensive treatments are needed

during 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 11 on page 56 for the next options. If

induction therapy resulted in less than a complete

remission, see Guide 17 on page 67 for the next