Acute Lymphoblastic Leukemia, Version 2.2015.
Treatment of acute lymphoblastic leukemia (ALL) continues to advance, as evidenced by the improved risk stratification of patients and development of newer treatment options. Identification of ALL subtypes based on immunophenotyping and cytogenetic and molecular markers has resulted in the inclusion of Philadelphia-like ALL and early T-cell precursor ALL as subtypes that affect prognosis. Identification of Ikaros mutations has also emerged as a prognostic factor. In addition to improved prognostication, treatment options for patients with ALL have expanded, particularly with regard to relapsed/refractory ALL. Continued development of second-generation tyrosine kinase inhibitors and the emergence of immunotherapy, including blinatumomab and chimeric antigen receptor T-cell therapy, have improved survival. Furthermore, incorporation of minimal residual disease (MRD) monitoring has shown insight into patient outcomes and may lead to treatment modification or alternative treatment strategies in select populations. This excerpt focuses on the sections of the ALL guidelines specific to clinical presentation and diagnosis, treatment of relapsed/refractory ALL, and incorporation of MRD monitoring. To view the most recent complete version of these guidelines, visit NCCN.org.
Joseph C
JC
Alvarnas
Patrick A
PA
Brown
Patricia
P
Aoun
Karen Kuhn
KK
Ballen
Stefan K
SK
Barta
Uma
U
Borate
Michael W
MW
Boyer
Patrick W
PW
Burke
Ryan
R
Cassaday
Januario E
JE
Castro
Peter F
PF
Coccia
Steven E
SE
Coutre
Lloyd E
LE
Damon
Daniel J
DJ
DeAngelo
Dan
D
Douer
Olga
O
Frankfurt
John P
JP
Greer
Robert A
RA
Johnson
Hagop M
HM
Kantarjian
Rebecca B
RB
Klisovic
Gary
G
Kupfer
Mark
M
Litzow
Arthur
A
Liu
Arati V
AV
Rao
Bijal
B
Shah
Geoffrey L
GL
Uy
Eunice S
ES
Wang
Andrew D
AD
Zelenetz
Kristina
K
Gregory
Courtney
C
Smith
D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D017410:Practice Guidelines as Topic; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000175:diagnosis* / Q000453:epidemiology / Q000473:pathology / Q000628:therapy*; D012307:Risk Factors