What are the NCCN recommendations for first-line treatment of acute lymphoblastic leukemia (ALL)?

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

As a general rule, the NCCN recommends enrolling patients with ALL in a clinical trial, if possible. Otherwise, NCCN recommendations for first-line treatment are based on risk stratification and age, as follows [16]

  • Philadelphia chromosome–positive (Ph+) ALL (in AYA): Chemotherapy and tyrosine kinase inhibitor (TKI), followed by allogeneic stem cell transplantation (SCT) if an appropriate donor is available; if transplantation is not feasible, continue multiagent chemotherapy and a TKI

  • Ph+ ALL (adults < 65 y): Chemotherapy and tyrosine kinase inhibitor (TKI); consider allogeneic SCT if an appropriate donor is available and the patient has good performance status and no or limited comorbidities; if transplantation is not feasible, continue multiagent chemotherapy and a TKI

  • Ph+ ALL (adults ≥65 y or with substantial comorbidities): TKI and corticosteroids or TKI and chemotherapy (evaluate end-organ reserve, end-organ dysfunction, and performance status)

  • Ph- ALL (AYA): Pediatric-style multiagent chemotherapy

  • Ph- ALL (Adults < 65 y): Multiagent chemotherapy

  • Ph- ALL (Adults ≥ 65 or with substantial comorbidities): Multiagent chemotherapy or corticosteroids (evaluate end-organ reserve, end-organ dysfunction)

NCCN strongly recommends central nervous system (CNS) prophylaxis for all ALL treatment groups.


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