What are the recommendations for addressing challenges in implementing asparaginase-based regimens in AYA patients with ALL?

The ALL Hub was pleased to speak with Ibrahim Aldoss, City of Hope, Duarte, US. We asked, What are the recommendations for addressing challenges in implementing asparaginase-based regimens in adolescent and young adult (AYA) patients with acute lymphoblastic leukemia (ALL)? 

Aldoss discusses the challenges associated with implementing asparaginase-based regimens in AYA patients with ALL, and shares recommendations to overcome them, as established and published by a US consensus panel in the American Journal of Hematology.¹ 

Key points¹ 

• Implementing asparaginase-based regimens in AYA patients with ALL can be challenging due to regimen complexity, toxicity monitoring and management concerns, limited facilities and clinical experience, and the lifestyle and psychosocial factors of AYA patients affecting access, adherence, and completion of these regimens. 
• Recommendations to overcome these challenges include: 
• Developing guidance for identifying appropriate AYA patients for asparaginase-based regimens. 
• Referring AYA patients to specialized centers with availability of clinical trials and/or experience with pediatric-inspired regimens. 
• Strategies to increase AYA patient enrollment in clinical trials. 
• Identifying patients with risk factors for toxicities, such as older age, obesity, and underlying liver disease. 
• Optimizing asparaginase dosing, establishing structured toxicity monitoring and management protocols for asparaginase regimens, and strategies to prevent or reduce the risk of asparaginase-related toxicities for high-risk patients. 
• Individualized strategies to address barriers to care, including the availability of experienced nurses and staff, and resources to support financial and travel burden. 
• Collaboration between treating centers and community practices. 
• Collaboration between pediatric practitioners, who generally have more experience with pediatric-inspired regimens compared with adult practitioners, and other teams.  
• Building multidisciplinary teams to address AYA patients’ needs.  
• Facilitating access to asparaginase therapy, and supporting adherence to complete the full regimen. 
• Communicating with AYA patients to set expectations regarding possible side effects and concurrent toxicities, and the long-term risk of pediatric-inspired regimens.  
• By implementing these strategies, healthcare teams can improve the feasibility, safety, and completion of asparaginase regimens in AYA patients with ALL, ultimately both improving clinical outcomes and the overall treatment experience for patients. 

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.