Induction therapy for Philadelphia chromosome positive acute lymphoblastic leukemia in adults
- Richard A Larson, MD
Richard A Larson, MD
- Editor-in-Chief — Hematology
- Section Editor — Leukemia
- Professor of Medicine
- University of Chicago Pritzker School of Medicine
Acute lymphoblastic leukemia (ALL) refers to a group of hematopoietic neoplasms involving cells committed to the lymphoid lineage. Philadelphia chromosome positive ALL (Ph+ ALL) is a biologically and clinically distinct variant of ALL classified as ALL with t(9;22)(q34;q11.2);BCR-ABL1 in the World Health Organization classification system . Ph+ ALL accounts for approximately 20 to 30 percent of ALL in adults and 2 to 3 percent of ALL in children [2,3].
This topic review will discuss induction therapy for Ph+ ALL in adults. The following related subjects are presented separately:
●The clinical and pathologic features and diagnosis of ALL. (See "Clinical manifestations, pathologic features, and diagnosis of precursor B cell acute lymphoblastic leukemia/lymphoma" and "Clinical manifestations, pathologic features, and diagnosis of precursor T cell acute lymphoblastic leukemia/lymphoma".)
●Induction therapy for Ph chromosome negative ALL in adults. (See "Induction therapy for Philadelphia chromosome negative acute lymphoblastic leukemia in adults".)
●Post-remission therapy for ALL in adults. (See "Post-remission therapy for Philadelphia chromosome positive acute lymphoblastic leukemia in adults" and "Post-remission therapy for Philadelphia chromosome negative acute lymphoblastic leukemia in adults".)
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- OVERVIEW OF THERAPY
- PRETREATMENT EVALUATION
- INDUCTION THERAPY
- Overview of induction
- Central nervous system prophylaxis
- TKI plus chemotherapy
- - Choice of chemotherapy regimen
- - Choice of TKI
- TKI plus steroid therapy
- SPECIAL SCENARIOS
- Central nervous system involvement
- Older or frail adults
- Young adults/adolescents
- Patients with Down syndrome
- Patients with cardiac disease
- MONITORING DURING TREATMENT
- EVALUATING RESPONSE TO INDUCTION
- POST-REMISSION THERAPY
- CLINICAL TRIALS
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS