Increasing completion of asparaginase treatment in childhood acute lymphoblastic leukaemia (ALL): Summary of an expert panel discussion

André Baruchel, Patrick Brown, Carmelo Rizzari, Lewis Silverman, Inge Van Der Sluis, Benjamin Ole Wolthers, Kjeld Schmiegelow

Research output: Contribution to journalReview articlepeer-review

Abstract

Insufficient exposure to asparaginase therapy is a barrier to optimal treatment and survival in childhood acute lymphoblastic leukaemia (ALL). Three important reasons for inactivity or discontinuation of asparaginase therapy are infusion related reactions (IRRs), pancreatitis and life-threatening central nervous system (CNS). For IRRs, real-time therapeutic drug monitoring (TDM) and premedication are important aspects to be considered. For pancreatitis and CNS thrombosis one key question is if patients should be re-exposed to asparaginase after their occurrence. An expert panel met during the Congress of the International Society for Paediatric Oncology in Lyon in October 2019 to discuss strategies for diminishing the impact of these three toxicities. The panel agreed that TDM is particularly useful for optimising asparaginase treatment and that when a tight pharmacological monitoring programme is established premedication could be implemented more broadly to minimise the risk of IRR. Re-exposure to asparaginase needs to be balanced against the anticipated risk of leukemic relapse. However, more prospective data are needed to give clear recommendations if to re-expose patients to asparaginase after the occurrence of severe pancreatitis and CNS thrombosis.

Original languageEnglish (US)
Article numbere000977
JournalESMO Open
Volume5
Issue number5
DOIs
StatePublished - Sep 23 2020

Keywords

  • CNS thrombosis
  • acute lymphoblastic leukemia
  • asparaginase
  • hypersensi
  • pancreatitis
  • premedication
  • therapeutic drug monitoring

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

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