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 guidance on asparaginase dosing and monitoring, hypersensitivity and inactivation, integration with frontline blinatumomab and antimetabolites, and adaptations for resource-limited acute lymphoblastic leukemia settings.
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An international expert panel presents consensus guidance on asparaginase dosing and monitoring, hypersensitivity and inactivation, integration with frontline blinatumomab and antimetabolites, and adaptations for resource-limited acute lymphoblastic leukemia settings.
Research significance
The record supports the clinical rationale that therapeutic drug monitoring and coordinated use of asparaginase with blinatumomab may improve treatment delivery and safety; whether these consensus strategies improve survival, toxicity, or treatment completion remains an inference requiring prospective comparative evaluation.
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.