NCCN Guidelines Insights: Acute Lymphoblastic Leukemia, Version 1.2019

Featured Updates to the NCCN Guidelines

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  • 1 The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins;
  • 2 UC San Diego Moores Cancer Center;
  • 3 UCSF Helen Diller Comprehensive Cancer Center;
  • 4 Dana-Farber/Brigham and Women’s Cancer Center;
  • 5 Roswell Park Comprehensive Cancer Center;
  • 6 Massachusetts General Hospital Cancer Center;
  • 7 University of Washington/Seattle Cancer Care Alliance;
  • 8 Mayo Clinic Cancer Center;
  • 9 Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute;
  • 10 City of Hope National Medical Center;
  • 11 The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute;
  • 12 Huntsman Cancer Institute at the University of Utah;
  • 13 University of Alabama at Birmingham Comprehensive Cancer Center;
  • 14 University of Michigan Rogel Cancer Center;
  • 15 Fred & Pamela Buffett Cancer Center;
  • 16 Stanford Cancer Institute;
  • 17 The University of Texas MD Anderson Cancer Center;
  • 18 Duke Cancer Institute;
  • 19 University of Colorado Cancer Center;
  • 20 Yale Cancer Center/Smilow Cancer Hospital;
  • 21 University of Wisconsin Carbone Cancer Center;
  • 22 Vanderbilt-Ingram Cancer Center;
  • 23 Memorial Sloan Kettering Cancer Center;
  • 24 St. Jude Children’s Research Hospital/The University of Tennessee Health Science Center;
  • 25 Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine;
  • 26 National Comprehensive Cancer Network; and
  • 27 Moffitt Cancer Center.
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Survival outcomes for older adults with acute lymphoblastic leukemia (ALL) are poor and optimal management is challenging due to higher-risk leukemia genetics, comorbidities, and lower tolerance to intensive therapy. A critical understanding of these factors guides the selection of frontline therapies and subsequent treatment strategies. In addition, there have been recent developments in minimal/measurable residual disease (MRD) testing and blinatumomab use in the context of MRD-positive disease after therapy. These NCCN Guidelines Insights discuss recent updates to the NCCN Guidelines for ALL regarding upfront therapy in older adults and MRD monitoring/testing in response to ALL treatment.

  • 1.

    Geyer MB, Hsu M, Devlin SM, . Overall survival among older US adults with ALL remains low despite modest improvement since 1980: SEER analysis. Blood 2017;129:18781881.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 2.

    Pulte D, Jansen L, Gondos A, . Survival of adults with acute lymphoblastic leukemia in Germany and the United States. PLoS One 2014;9:e85554.

  • 3.

    Wermann WK, Viardot A, Kayser S, . Comorbidities are frequent in older patients with de novo acute lymphoblastic leukemia (ALL) and correlate with induction mortality: analysis of more than 1200 patients from GMALL data bases [abstract]. Blood 2018;132(Suppl 1):Abstract 660.

    • Search Google Scholar
    • Export Citation
  • 4.

    Foà R, Vitale A, Vignetti M, . Dasatinib as first-line treatment for adult patients with Philadelphia chromosome-positive acute lymphoblastic leukemia. Blood 2011;118:65216528.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 5.

    Jabbour E, Kantarjian H, Ravandi F, . Combination of hyper-CVAD with ponatinib as first-line therapy for patients with Philadelphia chromosome-positive acute lymphoblastic leukaemia: a single-centre, phase 2 study. Lancet Oncol 2015;16:15471555.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 6.

    Martinelli G, Piciocchi A, Papayannidis C, . First report of the Gimema LAL1811 phase II prospective study of the combination of steroids with ponatinib as frontline therapy of elderly or unfit patients with Philadelphia chromosome-positive acute lymphoblastic leukemia [abstract]. Blood 2017;130(Suppl 1):Abstract 99.

    • Search Google Scholar
    • Export Citation
  • 7.

    Ottmann OG, Pfeifer H, Cayuela JM, . Nilotinib (Tasigna) and low intensity chemotherapy for first-line treatment of elderly patients with BCR-ABL1- positive acute lymphoblastic leukemia: final results of a prospective multicenter trial (EWALL-PH02) [abstract]. Blood 2018;132(Suppl 1):Abstract 31.

    • Search Google Scholar
    • Export Citation
  • 8.

    Rousselot P, Coudé MM, Gokbuget N, . Dasatinib and low-intensity chemotherapy in elderly patients with Philadelphia chromosome-positive ALL. Blood 2016;128:774782.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 9.

    Thomas DA, O’Brien SM, Faderl S, . Long-term outcome after hyper-CVAD and imatinib (IM) for de novo or minimally treated Philadelphia chromosome-positive acute lymphoblastic leukemia (Ph-ALL) [abstract]. J Clin Oncol 2010;28(Suppl):Abstract 6506.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 10.

    Wieduwilt MJ, Yin J, Wetzler M, . A phase II study of dasatinib and dexamethasone as primary therapy followed by transplantation for adults with newly diagnosed Ph/BCR-ABL1-positive acute lymphoblastic leukemia (Ph+ ALL): final results of Alliance/CALGB Study 10701 [abstract]. Blood 2018;132(Suppl 1):Abstract 309.

    • Search Google Scholar
    • Export Citation
  • 11.

    Gökbuget N. Treatment of older patients with acute lymphoblastic leukemia. Hematology Am Soc Hematol Educ Program 2016;2016:573579.

  • 12.

    Stengel A, Schnittger S, Weissmann S, . TP53 mutations occur in 15.7% of ALL and are associated with MYC-rearrangement, low hypodiploidy, and a poor prognosis. Blood 2014;124:251258.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 13.

    Roberts KG, Gu Z, Payne-Turner D, . High frequency and poor outcome of Philadelphia chromosome-like acute lymphoblastic leukemia in adults. J Clin Oncol 2017;35:394401.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 14.

    Guru Murthy GS, Venkitachalam R, Mehta P. Trends in survival outcomes of B-lineage acute lymphoblastic leukemia in elderly patients: analysis of Surveillance, Epidemiology, and End Results database. Leuk Lymphoma 2015;56:22962300.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 15.

    Jabo B, Morgan JW, Martinez ME, . Sociodemographic disparities in chemotherapy and hematopoietic cell transplantation utilization among adult acute lymphoblastic and acute myeloid leukemia patients. PLoS One 2017;12:e0174760.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 16.

    Kim C, Molony JT, Chia VM, . Patient characteristics, treatment patterns, and mortality in elderly patients newly diagnosed with ALL. Leuk Lymphoma 2018:17.

    • Search Google Scholar
    • Export Citation
  • 17.

    Kozlowski P, Lennmyr E, Ahlberg L, . Age but not Philadelphia positivity impairs outcome in older/elderly patients with acute lymphoblastic leukemia in Sweden. Eur J Haematol 2017;99:141149.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 18.

    Berry DA, Zhou S, Higley H, . Association of minimal residual disease with clinical outcome in pediatric and adult acute lymphoblastic leukemia: a meta-analysis. JAMA Oncol 2017;3:e170580.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 19.

    Brüggemann M, Raff T, Flohr T, . Clinical significance of minimal residual disease quantification in adult patients with standard-risk acute lymphoblastic leukemia. Blood 2006;107:11161123.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 20.

    Holowiecki J, Krawczyk-Kulis M, Giebel S, . Status of minimal residual disease after induction predicts outcome in both standard and high-risk Ph-negative adult acute lymphoblastic leukaemia. The Polish Adult Leukemia Group ALL 4-2002 MRD Study. Br J Haematol 2008;142:227237.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 21.

    Brüggemann M, Kotrova M. Minimal residual disease in adult ALL: technical aspects and implications for correct clinical interpretation. Blood Adv 2017;1:24562466.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 22.

    Kantarjian HM, Stein AS, Bargou RC, . Blinatumomab treatment of older adults with relapsed/refractory B-precursor acute lymphoblastic leukemia: results from 2 phase 2 studies. Cancer 2016;122:21782185.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 23.

    Martinelli G, Boissel N, Chevallier P, . Complete hematologic and molecular response in adult patients with relapsed/refractory Philadelphia chromosome-positive B-precursor acute lymphoblastic leukemia following treatment with blinatumomab: results from a phase II, single-arm, multicenter study. J Clin Oncol 2017;35:17951802.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 24.

    Topp MS, Gökbuget N, Stein AS, . Safety and activity of blinatumomab for adult patients with relapsed or refractory B-precursor acute lymphoblastic leukaemia: a multicentre, single-arm, phase 2 study. Lancet Oncol 2015;16:5766.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 25.

    Gökbuget N, Dombret H, Bonifacio M, . Blinatumomab for minimal residual disease in adults with B-cell precursor acute lymphoblastic leukemia. Blood 2018;131:15221531.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 26.

    Topp MS, Gökbuget N, Zugmaier G, . Long-term follow-up of hematologic relapse-free survival in a phase 2 study of blinatumomab in patients with MRD in B-lineage ALL. Blood 2012;120:51855187.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 27.

    Topp MS, Kufer P, Gökbuget N, . Targeted therapy with the T-cell-engaging antibody blinatumomab of chemotherapy-refractory minimal residual disease in B-lineage acute lymphoblastic leukemia patients results in high response rate and prolonged leukemia-free survival. J Clin Oncol 2011;29:24932498.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 28.

    Larson RA, Dodge RK, Burns CP, . A five-drug remission induction regimen with intensive consolidation for adults with acute lymphoblastic leukemia: cancer and leukemia group B study 8811. Blood 1995;85:20252037.

    • Search Google Scholar
    • Export Citation
  • 29.

    Larson RA, Dodge RK, Linker CA, . A randomized controlled trial of filgrastim during remission induction and consolidation chemotherapy for adults with acute lymphoblastic leukemia: CALGB study 9111. Blood 1998;92:15561564.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 30.

    Kantarjian H, Thomas D, O’Brien S, . Long-term follow-up results of hyperfractionated cyclophosphamide, vincristine, doxorubicin, and dexamethasone (Hyper-CVAD), a dose-intensive regimen, in adult acute lymphocytic leukemia. Cancer 2004;101:27882801.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 31.

    O’Brien S, Thomas DA, Ravandi F, . Results of the hyperfractionated cyclophosphamide, vincristine, doxorubicin, and dexamethasone regimen in elderly patients with acute lymphocytic leukemia. Cancer 2008;113:20972101.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 32.

    Maury S, Huguet F, Leguay T, . Adverse prognostic significance of CD20 expression in adults with Philadelphia chromosome-negative B-cell precursor acute lymphoblastic leukemia. Haematologica 2010;95:324328.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 33.

    Thomas DA, O’Brien S, Jorgensen JL, . Prognostic significance of CD20 expression in adults with de novo precursor B-lineage acute lymphoblastic leukemia. Blood 2009;113:63306337.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 34.

    Thomas DA, O’Brien S, Faderl S, . Chemoimmunotherapy with a modified hyper-CVAD and rituximab regimen improves outcome in de novo Philadelphia chromosome-negative precursor B-lineage acute lymphoblastic leukemia. J Clin Oncol 2010;28:38803889.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 35.

    Thomas D, O’Brien S, Faderl S, . Anthracycline dose intensification in adult acute lymphoblastic leukemia: lack of benefit in the context of the fractionated cyclophosphamide, vincristine, doxorubicin, and dexamethasone regimen. Cancer 2010;116:45804589.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 36.

    Hunault-Berger M, Leguay T, Thomas X, . A randomized study of pegylated liposomal doxorubicin versus continuous-infusion doxorubicin in elderly patients with acute lymphoblastic leukemia: the GRAALL-SA1 study. Haematologica 2011;96:245252.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 37.

    Goekbuget N, Beck J, Brueggemann M, . Moderate intensive chemotherapy including CNS-prophylaxis with liposomal cytarabine is feasible and effective in older patients with Ph-negative acute lymphoblastic leukemia (ALL): results of a prospective trial from the German Multicenter Study Group for Adult ALL (GMALL) [abstract]. Blood 2012;120:Abstract 1493.

    • Search Google Scholar
    • Export Citation
  • 38.

    Ribera JM, García O, Fernández-Abellán P, . Lack of negative impact of Philadelphia chromosome in older patients with acute lymphoblastic leukaemia in the tyrosine kinase inhibitor era: comparison of two prospective parallel protocols. Br J Haematol 2012;159:485488.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 39.

    Ribera JM, García O, Oriol A, . Feasibility and results of subtype-oriented protocols in older adults and fit elderly patients with acute lymphoblastic leukemia: results of three prospective parallel trials from the PETHEMA group. Leuk Res 2016;41:1220.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 40.

    Barry E, DeAngelo DJ, Neuberg D, . Favorable outcome for adolescents with acute lymphoblastic leukemia treated on Dana-Farber Cancer Institute Acute Lymphoblastic Leukemia Consortium Protocols. J Clin Oncol 2007;25:813819.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 41.

    Storring JM, Minden MD, Kao S, . Treatment of adults with BCR-ABL negative acute lymphoblastic leukaemia with a modified paediatric regimen. Br J Haematol 2009;146:7685.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 42.

    Martell MP, Atenafu EG, Minden MD, . Treatment of elderly patients with acute lymphoblastic leukaemia using a paediatric-based protocol. Br J Haematol 2013;163:458464.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 43.

    Berry DH, Pullen J, George S, . Comparison of prednisolone, vincristine, methotrexate, and 6-mercaptopurine vs. vincristine and prednisone induction therapy in childhood acute leukemia. Cancer 1975;36:98102.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 44.

    Hardisty RM, McElwain TJ, Darby CW. Vincristine and prednisone for the induction of remissions in acute childhood leukaemia. BMJ 1969;2:662665.

  • 45.

    Hess CE, Zirkle JW. Results of induction therapy with vincristine and prednisone alone in adult acute lymphoblastic leukemia: report of 43 patients and review of the literature. Am J Hematol 1982;13:6371.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 46.

    Rodriguez V, Hart JS, Freireich EJ, . Pomp combination chemotherapy of adult acute leukemia. Cancer 1973;32:6975.

  • 47.

    Ravandi F, O’Brien S, Thomas D, . First report of phase 2 study of dasatinib with hyper-CVAD for the frontline treatment of patients with Philadelphia chromosome-positive (Ph+) acute lymphoblastic leukemia. Blood 2010;116:20702077.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 48.

    Bassan R, Rossi G, Pogliani EM, . Chemotherapy-phased imatinib pulses improve long-term outcome of adult patients with Philadelphia chromosome-positive acute lymphoblastic leukemia: Northern Italy Leukemia Group protocol 09/00. J Clin Oncol 2010;28:36443652.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 49.

    Mizuta S, Matsuo K, Yagasaki F, . Pre-transplant imatinib-based therapy improves the outcome of allogeneic hematopoietic stem cell transplantation for BCR-ABL-positive acute lymphoblastic leukemia. Leukemia 2011;25:4147.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 50.

    Yanada M, Takeuchi J, Sugiura I, . High complete remission rate and promising outcome by combination of imatinib and chemotherapy for newly diagnosed BCR-ABL-positive acute lymphoblastic leukemia: a phase II study by the Japan Adult Leukemia Study Group. J Clin Oncol 2006;24:460466.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 51.

    Kim DY, Joo YD, Lim SN, . Nilotinib combined with multiagent chemotherapy for newly diagnosed Philadelphia-positive acute lymphoblastic leukemia. Blood 2015;126:746756.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 52.

    Chalandon Y, Thomas X, Hayette S, . Randomized study of reduced-intensity chemotherapy combined with imatinib in adults with Ph-positive acute lymphoblastic leukemia. Blood 2015;125:37113719.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 53.

    Ottmann OG, Wassmann B, Pfeifer H, . Imatinib compared with chemotherapy as front-line treatment of elderly patients with Philadelphia chromosome-positive acute lymphoblastic leukemia (Ph+ALL). Cancer 2007;109:20682076.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 54.

    Vignetti M, Fazi P, Cimino G, . Imatinib plus steroids induces complete remissions and prolonged survival in elderly Philadelphia chromosome-positive patients with acute lymphoblastic leukemia without additional chemotherapy: results of the Gruppo Italiano Malattie Ematologiche dell’Adulto (GIMEMA) LAL0201-B protocol. Blood 2007;109:36763678.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 55.

    Carlson CS, Emerson RO, Sherwood AM, . Using synthetic templates to design an unbiased multiplex PCR assay. Nat Commun 2013;4:2680.

  • 56.

    Denys B, van der Sluijs-Gelling AJ, Homburg C, . Improved flow cytometric detection of minimal residual disease in childhood acute lymphoblastic leukemia. Leukemia 2013;27:635641.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 57.

    Faham M, Zheng J, Moorhead M, . Deep-sequencing approach for minimal residual disease detection in acute lymphoblastic leukemia. Blood 2012;120:51735180.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 58.

    Gaipa G, Cazzaniga G, Valsecchi MG, . Time point-dependent concordance of flow cytometry and real-time quantitative polymerase chain reaction for minimal residual disease detection in childhood acute lymphoblastic leukemia. Haematologica 2012;97:15821593.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 59.

    Ladetto M, Brüggemann M, Monitillo L, . Next-generation sequencing and real-time quantitative PCR for minimal residual disease detection in B-cell disorders. Leukemia 2014;28:12991307.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 60.

    Short NJ, Jabbour E, Albitar M, . Recommendations for the assessment and management of measurable residual disease in adults with acute lymphoblastic leukemia: A consensus of North American experts. Am J Hematol 2019;94:257265.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 61.

    Stow P, Key L, Chen X, . Clinical significance of low levels of minimal residual disease at the end of remission induction therapy in childhood acute lymphoblastic leukemia. Blood 2010;115:46574663.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 62.

    Wood B, Wu D, Crossley B, . Measurable residual disease detection by high-throughput sequencing improves risk stratification for pediatric B-ALL. Blood 2018;131:13501359.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 63.

    Logan AC, Zhang B, Narasimhan B, . Minimal residual disease quantification using consensus primers and high-throughput IGH sequencing predicts post-transplant relapse in chronic lymphocytic leukemia. Leukemia 2013;27:16591665.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 64.

    Neale GA, Coustan-Smith E, Stow P, . Comparative analysis of flow cytometry and polymerase chain reaction for the detection of minimal residual disease in childhood acute lymphoblastic leukemia. Leukemia 2004;18:934938.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 65.

    Wu D, Emerson RO, Sherwood A, . Detection of minimal residual disease in B lymphoblastic leukemia by high-throughput sequencing of IGH. Clin Cancer Res 2014;20:45404548.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 66.

    Wu D, Sherwood A, Fromm JR, . High-throughput sequencing detects minimal residual disease in acute T lymphoblastic leukemia. Sci Transl Med 2012;4:134ra63.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 67.

    Kerst G, Kreyenberg H, Roth C, . Concurrent detection of minimal residual disease (MRD) in childhood acute lymphoblastic leukaemia by flow cytometry and real-time PCR. Br J Haematol 2005;128:774782.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 68.

    Pemmaraju N, Kantarjian H, Jorgensen JL, . Significance of recurrence of minimal residual disease detected by multi-parameter flow cytometry in patients with acute lymphoblastic leukemia in morphological remission. Am J Hematol 2017;92:279285.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 69.

    Kantarjian H, Stein A, Gökbuget N, . Blinatumomab versus chemotherapy for advanced acute lymphoblastic leukemia. N Engl J Med 2017;376:836847.

  • 70.

    Topp MS, Gökbuget N, Zugmaier G, . Phase II trial of the anti-CD19 bispecific T cell-engager blinatumomab shows hematologic and molecular remissions in patients with relapsed or refractory B-precursor acute lymphoblastic leukemia. J Clin Oncol 2014;32:41344140.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 71.

    Wolach O, Stevenson KE, Wadleigh M, . Allogeneic transplantation is not superior to chemotherapy in most patients over 40 years of age with Philadelphia-negative acute lymphoblastic leukemia in first remission. Am J Hematol 2016;91:793799.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 72.

    Campana D. Minimal residual disease in acute lymphoblastic leukemia. Hematology Am Soc Hematol Educ Program 2010;2010:712.

  • 73.

    Tasian SK, Hurtz C, Wertheim GB, . High incidence of Philadelphia chromosome-like acute lymphoblastic leukemia in older adults with B-ALL. Leukemia 2017;31:981984.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
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