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Guideline Updates

NCCN Updates Clinical Practice Guideline for ALL

January 22, 2020

The National Comprehensive Cancer Network (NCCN) updated its clinical practice guideline for acute lymphoblastic leukemia (ALL).

Across the entire guideline, the NCCN Categories of Preference have been applied to suggested treatment regimens.

In the algorithm for relapsed or refractory disease treatment, “B-cell ALL” was added to blinatumomab, inotuzumab ozogamicin, and tisagenlecleucel.

In the section for toxicity management for inotuzumab, blinatumomab, and tisagenlecleucel, “consider tocilizumab for patients with refractory CRS” was added to the blinatumomab section.

The sections for induction regimens for Ph-positive ALL features multiple new recommendations. Bosutinib has been added as a TKI option. For adolescents and young adults as well as adult patients, the CALGB 10701 regimen (TKI plus dexamethasone, vincristine, daunorubicin, methotrexate, etoposide, and cytarabine) was added. Additionally, “cyclophosphamide, vincristine, daunorubicin, dexamethasone, cytarabine, methotrexate, pegaspargase, and prednisone” was added to the bullet for the adolescent and young adult EsPhALL regimen.

For induction regimens for Ph-negative ALL, rituximab was added to the Linker 4-drug regimen for adult patients.

A minor change was made to the section for regimens for relapsed or refractory Ph-positive disease. The “Treatment Options Based on BCR-ABL1 Mutation Profile” table was updated to include contraindicated mutations.

In the section for regimens for relapsed or refractory Ph-negative disease, “inotuzumab ozogamicin plus mini-hyperCVD for B-cell ALL (cyclophosphamide, dexamethasone, vincristine, methotrexate, and cytarabine)” was added as a treatment option. This addition was also made to the section for treatment of older adults with Ph-negative ALL.—Zachary Bessette

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