Asparaginase optimization in AYA patients with ALL: US consensus panel recommendations

Results from a US expert consensus panel on optimizing asparaginase-based therapy for adolescent and young adult (AYAs; aged 15–39 years) patients with acute lymphoblastic leukemia/lymphoblastic lymphoma (ALL/LBL) were recently published in the American Journal of Hematology by Aldoss et al. 

Key data: The multidisciplinary panel identified barriers and other feasibility issues associated with effective asparaginase use in AYAs – including limited access to clinical trials, complex toxicity management, limited medical facilities and experienced staff to support with pediatric-inspired regimens (PIRs), and psychosocial or lifestyle challenges impacting adherence. Consensus recommendations included: develop guidance for identifying appropriate patients for asparaginase treatment, consider dose reduction or capping a dose for those patients with increased risk for toxicities, referral of AYA patients to specialized ALL/LBL treatment centers, routine therapeutic drug monitoring to detect silent inactivation, and multidisciplinary support to improve adherence.

Key learning: Optimal asparaginase treatment in AYA ALL requires collaborative pediatric–adult care models, proactive toxicity management, and patient-centered support systems. These strategies aim to ensure equitable access to and completion of asparaginase-based regimens – critical for improving survival outcomes in this age group.