Treatment for Ph-negative ALL for Adults up to 65 Years

Prior treatment

• History of clinically significant pancreatitis, at the investigator's discretion (taking into account the date of the pancreatitis, its previous severity, and sequelae).

Other illness

• Patients with a history of coronary artery disease, valvular heart disease, or hypertensive heart disease, which contraindicates the use of anthracyclines.
• Patients with active chronic liver disease.
• Patients with severe chronic respiratory failure.
• Renal insufficiency not due to ALL.
• Severe neurological disorders, not due to ALL, that contraindicate the use of these treatments (especially blinatumomab).
• Psychiatric or mental illness that prevents providing informed consent for sample submission or adequately participating in the study.

Age

• Age \> 65 years.

Other

• ALL type L3 or with mature B phenotype (sIg+) or with the cytogenetic alterations characteristic of mature B-cell ALL (t(8;14), t(2;8), t(8;22)).
• Ph-positive B-cell ALL (BCR::ABL1).
• Lymphoid blast crisis of chronic myeloid leukemia.
• Pregnancy or breastfeeding.
• Impaired general health (ECOG scores 3 and 4) not attributable to ALL.

• De novo ALL.
• Age 18-65 years.
• No prior treatment, except:
  • Urgent leukapheresis, Urgent treatment of hyperleukocytosis with hydroxyurea, Urgent cranial irradiation (one dose) for CNS leukostasis, Urgent mediastinal irradiation for superior vena cava syndrome.
• Adequate general condition (ECOG score 0-2), or \>2 if due to ALL.
• Negative pregnancy test for women of childbearing age.