In Ph-negative acute lymphoblastic leukemia, achieving complete remission is the primary goal of first-line induction. When that goal is not reached, a further treatment step is required.
First-line induction consists of a prephase with corticosteroids, followed by approximately four weeks of multi-agent induction — incorporating vincristine, dexamethasone, an anthracycline, and pegylated asparaginase, with intensive supportive care including granulocyte colony stimulating factor (G-CSF). The target is achievement of complete remission (CR rate approximately 90%). This protocol applies when that target has not been met.
The next step typically involves a second induction or first consolidation regimen. One standard approach uses a combination that includes cytarabine alongside other agents; alternative intensive combinations are also defined, with specific salvage options for refractory cases. The complete regimen, patient selection criteria, and full sequencing are available in the structured protocol.
DOI: 10.1182/blood.2023023568
View source ↗