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NCCN Guidelines for Patients



Acute Lymphoblastic Leukemia, Version 1.2017


Treatment guide

Older Adults with Ph-negative ALL

Guides 13 and 14

show the treatment options

for older adults with Ph-negative ALL in a 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.

Consolidation therapy options

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 factors described in Part 3. Your

general health, current symptoms, and side effects

will also be noted. This can help to decide if you

need and can tolerate more intensive treatment for


If you are younger than age 65, or you don’t have

other serious health problems, there are some main

options to choose from for consolidation therapy. See

Guide 12 on page

58. The options you have 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. 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 for when MRD is not found

or is unknown may include combinations of drugs

similar to those used for induction. In regimens

designed for adults, it tends to include drugs such as

methotrexate, cytarabine, and 6-MP. Chemotherapy

drugs are often given in higher (intensified) doses

during consolidation. CNS preventive treatment

is also usually given throughout this phase of


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.

Another option to consider if 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. It can cause very

severe side effects that may be too much for some

patients to take. Your doctor will look at a number

of factors to assess if an allogeneic SCT is a good

choice for you. This includes your age, general

health, and if you can tolerate intensive treatments.

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

health problems, there is one main option for


See Guide 13.

The option is to

stay on a chemotherapy regimen for consolidation

as described above for adults younger than age 65.

Allogeneic SCT is a very intense treatment and can

cause very severe side effects. Thus, it is often not

recommended if you are older than age 65 or you

have other serious health problems.

Maintenance therapy options

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.