First-line asparaginase and blinatumomab in ALL: Expert consensus recommendations

An international consensus statement on the safe and effective integration of asparaginase and blinatumomab in first-line acute lymphoblastic leukemia (ALL) treatment was published in Cancer by DeAngelo et al. 

Key data: A panel of 15 hemato-oncology experts developed consensus recommendations across four themes: optimal asparaginase dosing and therapeutic drug monitoring (TDM); prevention of hypersensitivity reactions (HSRs) and neutralizing antibody formation; integration of first-line blinatumomab, asparaginase, and antimetabolites; and asparaginase formulations in low-income and middle-income countries (LMICs). Selected consensus recommendations include: TDM of asparaginase is recommended to optimize administration and should be prioritized when a change in asparaginase product may be needed because of suspected HSRs or when dose adjustment may be required in individuals with obesity. The use of first-line pegylated asparaginase or calaspargase pegol is recommended because of its lower immunogenicity and longer duration of action. Blinatumomab should be included in first-line therapy for most patients with B-cell ALL (B-ALL), except those in very-low- or favorable-risk groups who have a low risk of relapse with conventional chemotherapy. Chemotherapy-free induction and consolidation with ponatinib and blinatumomab may benefit adults with Philadelphia chromosome-positive (Ph+) ALL. In LMICs, all asparaginase formulations should be quality assured either by a stringent regulatory authority (SRA) or through testing and TDM.

Key learning: These consensus recommendations outline specific, actionable guidance to optimize first-line asparaginase and blinatumomab therapy in patients with ALL.