What are the main barriers associated with implementing asparaginase-based regimens in AYA patients with ALL?

The ALL Hub spoke with Luke Maese, University of Utah Huntsman Cancer Institute and Primary Children’s Hospital, Salt Lake City, US. We asked, What are the main barriers associated with implementing asparaginase-based regimens in adolescent and young adult (AYA) patients with ALL. 

Maese discusses the challenges associated with treating AYA patients, a population who are positioned between pediatric and adult care. Maese explores how healthcare provider experience, available guidance, variations in AYA patient development, treatment-related toxicities, and psychosocial factors may impact asparaginase-based regimen delivery to AYA patients with ALL. 

Key points¹

• Asparaginase-based regimens are traditionally used to treat pediatric patients with ALL; therefore, familiarity and expertise may be limited among clinicians treating older populations. 
  • AYA patients occupy a unique position between adult and pediatric care, with treatment approaches for ALL varying according to the individual’s stage of adolescent development.
  • A lack of familiarity and expertise can lead to defaulting to non-asparaginase regimens in AYA patients.
• Institutional systems may lack embedded protocols or the necessary infrastructure to treat and manage AYA patients with ALL using asparaginase-based regimens.
• Treatment-related toxicities associated with asparaginase-based regimens can be less predictable in the diverse AYA population, as pediatric patients generally tolerate intense chemotherapeutic regimens better than older patients.
• Lifestyle and psychosocial aspects of typical AYA patients, such as home, school, and work responsibilities, may result in logistical challenges that can interfere with asparaginase-based treatment schedules and impact adherence to asparaginase-based regimens.
• Overall, barriers associated with implementing asparaginase-based regimens in AYA patients with ALL span clinical, institutional, and patient-centered domains, highlighting the need for recommendations to improve implementation and treatment in this population.

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.