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59

NCCN Guidelines for Patients

®

:

Acute Lymphoblastic Leukemia, Version 1.2017

5

Treatment guide

Older Adults with Ph-negative ALL

When choosing an induction regimen, your doctors

will look at your age, general health, organ function,

and other current health conditions. This will help

your doctor to know if you are able to receive very

strong treatments.

If you are younger than age 65, or without serious

health problems, there are two main options to

choose from. Treatment within a clinical trial is

preferred if one is open and is the right fit for

you. The other option is to receive multiagent

chemotherapy based on a regimen designed for

adults. Induction regimens for adults tend to use

a combination of vincristine, a steroid (prednisone

or dexamethasone), cyclophosphamide, and

doxorubicin or daunorubicin.

If you are age 65 or older, or you have other

serious health problems, there are three main

options to choose from. Treatment within a clinical

trial is preferred if one is open and is the right fit

for you. The second option is to have multiagent

chemotherapy based on a regimen for adults as

described above. The third option is treatment

with corticosteroids such as prednisone or

dexamethasone with our without vincristine. This

option is not designed to cure ALL, but rather

to control the symptoms and improve the blood

counts. These drugs may be easier to take than

chemotherapy. Some patients may not be able to

tolerate the side effects of intensive (high-dose)

regimens. If needed, some chemotherapy drugs may

be given in lower doses to lessen the side effects.

Response

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. (See page 37 for more

details about treatment responses.)

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. But, bone marrow

is preferred. Testing for MRD can help your doctor

decide if more intensive treatments are needed for

consolidation.

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. See

Next steps

at the end of this section.

Next steps

If induction therapy resulted in a complete remission,

see Guide 13 and 14 on page 60 for the next options.

If induction therapy resulted in less than a complete

remission, see Guide 17 on page 67 for the next

options.