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NCCN Guidelines for Patients



Acute Lymphoblastic Leukemia, Version 1.2017


Treatment guide

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

chromosome changes.

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.

Next steps

After the allogeneic SCT or after completing

consolidation and maintenance therapy, see Guide

15 on page 63 for follow-up testing.