All content on this site is intended for healthcare professionals only. By acknowledging this message and accessing the information on this website you are confirming that you are a Healthcare Professional. If you are a patient or carer, please visit Know ALL.

The ALL Hub uses cookies on this website. They help us give you the best online experience. By continuing to use our website without changing your cookie settings, you agree to our use of cookies in accordance with our updated Cookie Policy

Introducing

Now you can personalise
your ALL Hub experience!

Bookmark content to read later

Select your specific areas of interest

View content recommended for you

Find out more
  TRANSLATE

The ALL Hub website uses a third-party service provided by Google that dynamically translates web content. Translations are machine generated, so may not be an exact or complete translation, and the ALL Hub cannot guarantee the accuracy of translated content. The ALL Hub and its employees will not be liable for any direct, indirect, or consequential damages (even if foreseeable) resulting from use of the Google Translate feature. For further support with Google Translate, visit Google Translate Help.

Steering CommitteeAbout UsNewsletterContact
LOADING
You're logged in! Click here any time to manage your account or log out.
LOADING
You're logged in! Click here any time to manage your account or log out.

The ALL Hub is an independent medical education platform, sponsored by Jazz Pharmaceuticals, Amgen, and Pfizer. The funders are allowed no direct influence on our content. The levels of sponsorship listed are reflective of the amount of funding given. View funders.

2024-10-08T12:14:14.000Z

How to optimize dosing regimens for recombinant asparaginase in ALL?

Featured
Oct 8, 2024
Share:
Learning objective: After reading this, learners will be able to state the best practice use of agents in ALL, including correct patient selection and the management of adverse events.

Bookmark this article

The ALL Hub spoke with Wendy Stock, The University of Chicago, Chicago, US. We asked, How to optimize dosing regimens for recombinant asparaginase in acute lymphoblastic leukemia (ALL)?

How to optimize dosing regimens for recombinant asparaginase in ALL?

In this interview, Wendy Stock discusses the challenges of managing asparaginase treatment in adults with ALL. Stock highlights the effectiveness of the therapy in younger adults but notes the difficulties of optimizing asparaginase dosing and managing associated toxicities, including hepatic issues, thrombosis, and pancreatitis. Stock points out the lack of formal guidelines and underscores the need for further research, including therapeutic drug monitoring and studies on anticoagulation. Ongoing studies aim to improve understanding of the risk factors for experiencing adverse events and how to optimize treatment approaches for better patient outcomes.

 Key learnings

  • The introduction of asparaginase has resulted in improved outcomes, particularly for young adults with ALL. However, dosing asparaginase can be challenging in certain populations, including older adults, due to its associated toxicities and the lack of formal guidelines.
  • There are a lack of data to identify whether current asparaginase dosing is appropriate or too high, and more research, particularly with therapeutic drug monitoring, is needed to tailor dosing appropriately.
  • Common toxicities associated with asparaginase treatment include hepatic toxicity, transaminitis, and hyperbilirubinemia. Serious toxicities involve thrombosis, particularly sagittal vein thrombosis, and pancreatitis. 
  • Where serious pancreatitis occurs, patients cannot be retreated with asparaginase.
  • Preventing and managing toxicities is complex because it is hard to predict who will develop a toxicity. Therapeutic monitoring and initiating treatment with lower doses in patients with hepatic dysfunction, diabetes, or who are morbidly obese may help to reduce toxicity, but prospective studies are needed.
  • Addressing thrombotic events, particularly in the first few months of treatment, is important. There are no formal anticoagulation guidelines and individual centers approach anticoagulation differently, such as using antithrombin monitoring or prophylactic enoxaparin.
  • Despite ongoing research, formal guidelines for asparaginase management, including anticoagulation and toxicity management, are lacking, highlighting the need for more data on these topics.
    • The American Society of Hematology (ASH) is creating new clinical practice guidelines for treating adolescents and young adults with ALL, as part of the ASH Clinical Practice Guidelines on Acute Lymphoblastic Leukemia.

 

I commit to reviewing the latest clinical data and recommendations for the optimal dosing of recombinant asparaginase in ALL to reduce and manage toxicities.

Agree

100%

Disagree

0%

2 votes

This educational resource is independently supported by Jazz Pharmaceuticals. All content is developed by SES in collaboration with an expert steering committee; funders are allowed no influence on the content of this resource.


Newsletter

Subscribe to get the best content related to ALL delivered to your inbox