Optimizing safety and efficacy of asparaginase and blinatumomab therapy in frontline acute lymphoblastic leukemia regimens in diverse health care settings—international expert consensus
Abstract
Frontline blinatumomab combined with chemotherapy has resulted in improved outcomes in both pediatric and adult patients with acute lymphoblastic leukemia and is considered the new cornerstone of acute lymphoblastic leukemia treatment. The role of asparaginase in this new landscape of acute lymphoblastic leukemia treatment was extensively discussed by an expert panel of hemato-oncologists to reach a consensus on the safety and efficacy of asparaginase in diverse settings with and without blinatumomab. Herein, the following consensus topics are presented: (1) optimal dosing of asparaginase and therapeutic drug monitoring; (2) prevention of asparaginase hypersensitivity reactions and inactivation; (3) integration of frontline blinatumomab, asparaginase, and antimetabolites; and (4) special issues of asparaginase formulations and adaptations for resource-limited settings.
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Authors: Daniel J. DeAngelo, Anna Avagyan, J Alfaro, Valentino Conter, Maria Lúcia de Martino Lee, Łukasz Hutnik, Miriam Hwang, Hiroto Inaba, Atsushi Manabe, Jae H. Park, Rob Pieters, Carmelo Rizzari, Vaskar Saha, David T. Teachey, Inge M. van der Sluis, Scott C. Howard
Institutions: Children's Hospital of Philadelphia, University of Manchester, Hokkaido University, Dana-Farber Cancer Institute, Medical University of Warsaw, Memorial Sloan Kettering Cancer Center, Cancer Research UK Manchester Institute, St. Jude Children's Research Hospital, Unidad de Cirugía Cardiovascular de Guatemala, Princess Máxima Center, Azienda Ospedaliera San Gerardo, Center of Medical Genetics and Primary Health Care, Liga Nacional Contra el Cáncer, Beneficência Portuguesa de São Paulo