NCCN Guidelines for Patients
Acute Lymphoblastic Leukemia, Version 1.2017
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.