What are the NCCN guidelines for risk stratification and treatment planning in acute lymphoblastic leukemia (ALL)?

Updated: Jul 17, 2018
  • Author: Karen Seiter, MD; Chief Editor: Emmanuel C Besa, MD  more...
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Answer

For optimal risk stratification and treatment planning in patients with ALL, the NCCN advises that bone marrow or peripheral blood lymphoblasts must be tested for specific recurrent genetic abnormalities, as follows [16] :

  • Cytogenetics – Karyotyping of G-banded metaphase chromosomes
  • Interphase fluorescence in situ hybridization (FISH, ALL panel to include testing for  BCR-ABL1MLLTEL/AML - ETV6/RUNX1, CEP4 and CEP10)
  • Reverse transcriptase polymerase chain reaction (RT-PCR) for fusion genes (eg,  BCR-ABL1), including determination of transcript size; in  BCR-ABL1–negative cases, testing for other fusions that are associated with Ph-like ALL may be considered
  • Additional assessment (array cGH) may be considered in cases of aneuploidy or failed karyotype

Nextgen sequencing is frequently performed, however the therapeutic and prognostic implicatons of the findings are still evolving in ALL.

See also Acute Lymphoblastic Leukemia Staging.


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