What are the key clinical considerations for asparaginase-based regimens in pediatric vs AYA patients with ALL?

The ALL Hub was pleased to speak with Luke Maese, University of Utah Huntsman Cancer Institute and Primary Children's Hospital, Salt Lake City, US. We asked, What are the key clinical considerations for asparaginase-based regimens in pediatric vs adolescent/young adult (AYA) patients with acute lymphoblastic leukemia (ALL)?

Key points

Medical considerations

• Body composition differs significantly between younger children and AYA populations, with obesity more prevalent and severe in older patients.¹
• Asparaginase-related toxicities include liver toxicity, pancreatitis, thrombosis, and hypersensitivity reactions – the risk of some of which may be increased in obese patients.¹
• Hypersensitivity/allergic reactions to asparaginase appear to be more common in pediatric vs AYA patients.²
  • Those who experience hypersensitivity reactions or silent inactivation may require alternative asparaginase formulations to maintain optimal therapy and compliance.²
• Asparaginase-based regimens have demonstrated superior efficacy vs other therapeutic options in pediatric patients with ALL and remain the standard of care in this population.¹
• Asparaginase-based regimens have also demonstrated efficacy and are a primary treatment option in AYA patients, although other approaches may be considered based on individual patient profiles.^1,3
• Treatment decisions in both pediatric and AYA patients must balance toxicity risks and efficacy profiles on an individual basis.^1,3

Psychosocial considerations

• Pediatric patients benefit from caregiver oversight, ensuring better treatment compliance and monitoring, although newer, more complex, pediatric protocols may provide compliance challenges.³
• AYA patients often manage their own care, raising concerns about adherence to complex treatment protocols.³

Institutional factors

• Pediatric centers routinely use asparaginase and have expertise in monitoring and managing associated toxicities.³
• AYA hospitals may lack familiarity with asparaginase-based regimens and toxicity management.³
• Consultation with high-volume pediatric ALL centers is recommended when treating patients at less experienced institutions.³
• Collaborative care between institutions can optimize outcomes for AYA patients.³

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