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NCCN Guidelines for Patients



Acute Lymphoblastic Leukemia, Version 1.2017


Treatment guide

Relapsed or refractory Ph-negative ALL

Relapsed or refractory Ph-negative ALL

Guide 17. Treatment for relapsed or refractory Ph-negative ALL

Status Treatment options

Refractory ALL


Relapsed ALL

• Clinical trial

• Chemotherapy regimen for relapsed or refractory ALL ± allogeneic SCT

• Blinatumomab

Chemotherapy regimens for relapsed or refractory Ph-negative ALL:

• Blinatumomab for B-cell ALL

• Regimens with cytarabine

• Combination regimens with alkylating agents

• Nelarabine for T-cell ALL

• Augmented hyper-CVAD regimen

• VSLI (









• Regimens with clofarabine for B-cell ALL

• MOpAD regimen includes methotrexate, vincristine, pegaspargase, and

dexamethasone, with rituximab for CD20-positive disease

Guide 17

shows the treatment options for relapsed

or refractory Ph-negative ALL. Ph-negative means

the leukemia cells do not have the Philadelphia


A relapse is when leukemia cells come back after

a complete remission. Refractory means that the

leukemia cells didn’t respond to treatment. ALL that

isn’t in complete remission after induction therapy

is called refractory ALL. (See page 37 to read more

about treatment responses.) Similar treatments are

used for relapsed ALL and refractory ALL.

Treatment options

Your doctor will look at a number of factors unique

to you to decide which treatment is the best choice.

Some factors include your age, general health,

symptoms, and side effects. This helps your doctor

to know if you are healthy enough to receive strong

treatments. How well prior treatment worked and how

long the treatment response lasted may also affect

which option is best.

There are several treatment options to choose

from. But, any treatment given should include

CNS preventive treatment. The options for treating

relapsed and refractory ALL are described next.