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56

NCCN Guidelines for Patients

®

:

Acute Lymphoblastic Leukemia, Version 1.2017

5

Treatment guide

AYAs with Ph-negative ALL

Guide 11. Postremission consolidation and maintenance

MRD results Consolidation therapy options Next options

Persistent or late MRD

ª

• Blinatumomab

• Consider allogeneic SCT

ª

• Start follow-up testing

MRD not found

ª

• Continue multiagent

chemotherapy regimen

ª

• Maintenance therapy with:

• Monthly vincristine/

prednisone pulses

• Weekly methotrexate

• Daily 6-MP

• Consider allogeneic SCT

ª

• Start follow-up testing

MRD unknown

ª

• Allogeneic SCT

• Consider continuing

multiagent chemotherapy

regimen

ª

• After chemotherapy,

maintenance therapy with:

• Monthly vincristine/

prednisone pulses

• Weekly methotrexate

• Daily 6-MP

• After SCT, start follow-up

testing

Guide 11

shows the treatment options for AYAs

with Ph-negative ALL in complete remission after

induction therapy. Consolidation therapy is the

second phase of treatment for ALL. The goal of this

phase is to kill any leukemia cells that may still be

in your body. It is followed by maintenance therapy.

These phases are jointly referred to as postremission

therapy since they are given after ALL is in remission.

Your doctor will look at many factors to help plan

consolidation therapy. This includes the ALL cell

subtype, chromosome changes, results of MRD

testing, and other prognostic factors. Your general

health, current symptoms, and side effects will

also be considered. This can help to decide if you

need and can tolerate more intensive treatment for

consolidation.

Consolidation therapy options

There are some main options to choose from for

consolidation therapy. The options depend on

whether or not MRD is found.

If MRD is found, that means the disease is persistent,

so your doctor may consider blinatumomab. This

medication has been shown to be helpful in treating

disease that continues despite other treatment. It

is known as a bispecific T-cell engager for how it

works with the immune system to find and attack

leukemia cells. It can cause serious side effects, so

your doctor will assess your health and monitor you

closely if you take this drug. An allogeneic SCT may

also be considered.