Optimizing safety and efficacy of asparaginase and blinatumomab therapy in frontline acute lymphoblastic leukemia regimens in diverse health care settings-international expert consensus.
An international expert panel presents consensus considerations for dosing, therapeutic drug monitoring, hypersensitivity prevention, and integration of asparaginase with frontline blinatumomab-based acute lymphoblastic leukemia regimens across diverse health care settings.
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An international expert panel presents consensus considerations for dosing, therapeutic drug monitoring, hypersensitivity prevention, and integration of asparaginase with frontline blinatumomab-based acute lymphoblastic leukemia regimens across diverse health care settings.
Research significance
The record supports expert consensus that optimized asparaginase dosing, monitoring, and toxicity management may preserve its efficacy and safety when combined with frontline blinatumomab; whether these adaptations improve outcomes over existing protocols remains an inference requiring prospective comparative testing.
Source 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.