NCCN Guidelines for Patients
Acute Lymphoblastic Leukemia, Version 1.2017
AYAs with Ph-negative ALL
Your doctor will look at a number of factors to decide
if an allogeneic SCT is a good choice for you. This
depends on your age, general health, and ability to
tolerate intensive treatments.
Consolidation therapy when MRD is not found or is
unknown may include combinations of drugs similar
to those used for induction. In pediatric-inspired
regimens, it tends to include high-dose methotrexate,
cytarabine, 6-MP, and pegaspargase. Chemotherapy
drugs are often given in higher (intensified) doses
during consolidation. CNS preventive treatment
is also usually given throughout this phase of
Another option to consider when MRD is not found or
is unknown is allogeneic SCT. This is a very intensive
treatment performed in specialized centers, and
may not be a good choice for everyone. Your doctor
may consider this option if tests found MRD after
induction, even if MRD is not found later in treatment.
This may also be a good choice if the leukemia cells
have certain poor risk features. A poor risk feature is
something that increases the chance that ALL might
come back after treatment. Examples of poor risk
features include having less than the normal number
of chromosomes or having five or more abnormal
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.
Next options and maintenance therapy
After consolidation with an allogeneic SCT, you
will begin follow-up testing. After consolidation
with multiagent chemotherapy, you will receive
maintenance therapy. Maintenance therapy is the
third phase of ALL treatment.
Maintenance therapy is given to keep (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.
If you are not treated with an allogeneic SCT, you will
likely be treated with a maintenance chemotherapy
regimen for 2 to 3 years. 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. This regimen
may include weekly methotrexate, daily 6-MP,
monthly vincristine, and a steroid (prednisone or
dexamethasone). Methotrexate and 6-MP can affect
the liver or lead to low blood counts, and may require
dose reduction or discontinuation.
After the allogeneic SCT or after completing
consolidation and maintenance therapy, see Guide
15 on page 63 for follow-up testing.