First-Line Treatment of ALK-Negative Anaplastic Large Cell Lymphoma
Anaplastic large cell lymphoma (ALCL) that is anaplastic lymphoma kinase (ALK)-negative is a clinically distinct subtype with specific first-line treatment considerations.
Clinical scenario: Anaplastic large-cell lymphoma that is anaplastic lymphoma kinase (ALK)-negative.
Treatment approach
First-line management involves chemotherapy, with the choice of regimen and the role of consolidation — whether radiation-based or transplant-based — determined by disease stage and individual patient risk factors.
Full regimen details, eligibility criteria, and sequencing are available in the complete structured protocol →
References
DOI: 10.1016/j.annonc.2025.07.014
- First-line treatment of anaplastic lymphoma kinase (ALK)-negative anaplastic large-cell lymphoma (ALCL):
- In patients with limited-stage, non-bulky disease and a favourable pre-therapeutic risk profile, abbreviated ChT [e.g. three to four cycles of BV—cyclophosphamide—doxorubicin—prednisolone (BV-CHP) or CHOEP] [III, B] followed by consolidative ISRT (e.g. 30-40 Gy) [IV, B] can be recommended.
- All other ChT-eligible patients should be offered six cycles of BV-CHP [I, A].
- Six cycles of CHO(E)P is an alternative for patients with advanced-stage disease [III, B].
- Consolidative ISRT can be recommended for patients with stage I-II, bulky or IPI >1 disease after six cycles of BV-CHP or CHO(E)P [IV, B].
- Consolidative ASCT in first CR can be considered for transplant-eligible, chemosensitive patients with stage III-IV disease [II, B].
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