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58

NCCN Guidelines for Patients

®

:

Acute Lymphoblastic Leukemia, Version 1.2017

5

Treatment guide

Older adults with Ph-negative ALL

Older adults with Ph-negative ALL

Guide 12. Remission induction for older adults with Ph-negative ALL

Health status Induction therapy options Response

Patients <65 years of

age without serious

health problems

ª

• Clinical trial

• Multiagent

chemotherapy regimen

ª

ª

Complete remission,

monitor for MRD

Less than complete

remission, start treatment

for relapsed/refractory ALL

Patients ≥65 years of

age or with other

serious health problems

ª

• Clinical trial

• Multiagent

chemotherapy regimen

• Corticosteroids

ª

ª

Complete remission,

monitor for MRD

Less than complete

remission, start treatment

for relapsed/refractory ALL

Guide 12

shows the induction therapy options for

older adults 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 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

treatment.

There are many treatment regimens used for adults

with ALL. These regimens are typically designed to

include steroids, vincristine, doxorubicin, cytarabine,

and/or methotrexate. Rituximab may also be included

if the leukemia expresses the CD20 protein.

There are many treatment regimens used for adults

with ALL. These regimens usually include a steroid

and chemotherapy agents such as vincristine,

doxorubicin, cytarabine, cyclophosphamide, and/

or methotrexate. Rituximab may also be included

if the leukemia expresses the CD20 protein. Your

doctor may also consider other drugs as part of the

treatment regimen.

CNS preventive treatment is given to all patients

during 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, and cytarabine, 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.

Induction therapy options

Often, age 65 is the cut-off for intensive treatment.

But, age alone is not a good gauge of a person’s

overall health or fitness for intensive treatment.