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1、Version 2 2019 05 15 19 2019 National Comprehensive Cancer Network NCCN All rights reserved NCCN Guidelines and this illustration may not be reproduced in any form without the express written permission of NCCN NCCN Clinical Practice Guidelines in Oncology NCCN Guidelines Acute Lymphoblastic Leukemi
2、a Version 2 2019 May 15 2019 Continue NCCN org NCCN Guidelines Version 2 2019 Acute Lymphoblastic Leukemia Version 2 2019 05 15 19 2019 National Comprehensive Cancer Network NCCN All rights reserved NCCN Guidelines and this illustration may not be reproduced in any form without the express written p
3、ermission of NCCN NCCN Guidelines Index Table of Contents Discussion Peter F Coccia MD Fred 22 q34 1 q11 2 BCR ABL1 t v 11q23 3 KMT2A rearranged t 12 21 p13 2 q22 1 ETV6 RUNX1 t 1 19 q23 p13 3 TCF3 PBX1 t 5 14 q31 1 q32 3 IL3 IGH B cell lymphoblastic leukemia lymphoma not otherwise specified Provisi
4、onal entities B lymphoblastic leukemia lymphoma BCR ABL1Ph like B lymphoblastic leukemia lymphoma with iAMP21 early T cell precursor lymphoblastic leukemia Footnote d modified While these guidelines pertain primarily to patients with leukemia patients with lymphoblastic lymphoma LL B or T cell would
5、 likely also benefit from ALL like regimens versus traditional lymphoma therapy Such patients should be treated in a center that has experience with LL ALL 2 Bullet 10 modified CT of neck chest abdomen pelvis with IV contrast as indicated for symptoms Last bullet modified Strongly consider human leu
6、kocyte antigen HLA typing and early evaluation and search for family or an alternative donor Footnote k modified Timing of LP should be consistent with the chosen treatment regimen Pediatric inspired regimens typically include LP and prophylactic IT chemotherapy at the time of diagnostic workup The
7、panel recommends that first LP be done concurrently with initial IT therapy performed at time of initial scheduled IT therapy unless directed by symptoms to perform earlier ALL 3 Consolidation Therapy after Complete Response modified Allogeneic HCT if a donor is availablein appropriate candidates or
8、 If allogeneic HCT is not available Continue multiagent chemotherapy TKI also applies to ALL 4 Footnote o is new to the page It is reasonable to approach the initial treatment of blast phase CML with similar strategies to Ph ALL with a goal of proceeding to HCT also applies to ALL 4 Footnote u updat
9、ed with additional reference Footnote v added Many variables determine eligibility for allogeneic HCT including donor availability depth of remission comorbidities and social support also applies to ALL 4 ALL 5 ALL 6 Footnote x modified Duration of post HCT or maintenance TKI should be a minimum of
10、a year Optimal duration is unknown The recommended duration of TKI after HCT is at least one year The recommended duration of TKI during maintenance chemotherapy is at least until completion of maintenance chemotherapy The optimal duration of TKI is unknown in both settings also applies to ALL 4 ALL
11、 4 Patients 65 years of age or with substantial comorbidities Complete response Monitoring for MRD added Footnote removed Allogeneic HCT may be considered based on performance status comorbidities availability of appropriate transplant donor and transplant center expertise in treating older patients
12、 with allogeneic HCT also applies to ALL 6 ALL 5 Pediatric inspired regimens noted as preferred MRD unknown changed to MRD unavailable also applies to ALL 6 Footnote cc added See Supportive Care Toxicity Management ALL C 2 of 4 also applies to ALL 6 ALL 8 Footnote ee second sentence modified Data de
13、monstrating the effect of WBC counts on prognosis are less firmly established for adults than for the pediatric population and likely superseded by MRD quantification after treatment also applies to ALL 6 Updates in Version 1 2019 of the NCCN Guidelines for Acute Lymphoblastic Leukemia from Version
14、1 2018 include Continued Updates in Version 2 2019 of the NCCN Guidelines for Acute Lymphoblastic Leukemia from Version 1 2019 include MS 1 The Discussion section was updated to reflect the changes in the algorithm Printed by Maria Chen on 5 22 2019 11 36 53 PM For personal use only Not approved for
15、 distribution Copyright 2019 National Comprehensive Cancer Network Inc All Rights Reserved NCCN Guidelines Version 2 2019 Acute Lymphoblastic Leukemia Version 2 2019 05 15 19 2019 National Comprehensive Cancer Network NCCN All rights reserved NCCN Guidelines and this illustration may not be reproduc
16、ed in any form without the express written permission of NCCN NCCN Guidelines Index Table of Contents Discussion UPDATES Updates in Version 1 2019 of the NCCN Guidelines for Acute Lymphoblastic Leukemia from Version 1 2018 include ALL 5 Footnote ff added Consider retesting for MRD at first available opportunity also applies to ALL 6 ALL 7 Reference to testicular exam removed this is considered part of physical exam CSF monitoring and echocardiogram removed If bone marrow aspirate modified as cli
