Overview
Building Clinical Capacity for Optimal Asparaginase-Based Treatment in Acute Lymphoblastic Leukemia and Lymphoblastic Lymphoma: Approaches in Pediatric, Adult, and Adolescent and Young Adult Patients
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Asparaginase, a cornerstone of regimens for acute lymphoblastic leukemia (ALL) and lymphoblastic lymphoma (LBL) in pediatric and adult patients, is frequently complicated by a distinct spectrum of toxicities which pose significant clinical management challenges. The management of ALL/LBL in adolescent and young adults (AYA) is particularly complex, and these patients often have reduced survival due to their unique needs, challenges with transitions of care, and divergent management across different providers and settings.
To mitigate barriers and improve outcomes in patients with ALL/LBL, this interactive guide interweaves education and practical guidance for easy integration of the latest evidence into daily clinical protocols and processes
This educational activity is designed for academic and community hematologists/oncologists, oncology pharmacists, advanced practice providers and nurses in hematology practice, and other members of the multidisciplinary team.
Asparaginase is a cornerstone of regimens for acute lymphoblastic leukemia (ALL) and lymphoblastic lymphoma (LBL) in pediatric and adult patients. Asparaginase-based therapy is frequently complicated by a distinct spectrum of toxicities, including hypersensitivity reactions, hepatotoxicity, thrombotic events, and pancreatitis, which pose significant clinical management challenges. Further, hypersensitivity and silent inactivation can result in diminished therapeutic effectiveness and poorer outcomes if not appropriately identified and addressed. Novel asparaginase formulations offer alternatives for patients experiencing hypersensitivity to E. coli-derived asparaginase, but these preparations possess distinct pharmacokinetic and immunogenic profiles that necessitate tailored management approaches.
The management of ALL/LBL in adolescent and young adults (AYA) is complex, and these patients often have reduced survival due to their unique needs, challenges with transitions of care, and divergent management across different providers and settings. For example, pediatric-inspired regimens improve outcomes in AYA, but adoption has been inconsistent due to logistical complexity, outpatient adherence challenges, and unclear pathways for integrating monitoring and toxicity management into workflows. There is also persistent variability in the implementation of monitoring protocols. To address these challenges, new guidelines specific to the AYA population were recently released.
To mitigate barriers and improve outcomes in patients with ALL/LBL, this interactive guide interweaves education and practical guidance for easy integration of the latest evidence into daily clinical protocols and processes.
Upon completion of this activity, learners will be able to:
- Describe the pharmacokinetic and immunologic differences among available asparaginase formulations used in acute lymphoblastic leukemia (ALL) and lymphoblastic lymphoma (LBL) treatment
- Outline strategies for differentiating between clinical hypersensitivity and silent inactivation using therapeutic drug monitoring (TDM) and serum asparaginase activity (SAA) assays
- Discuss the importance of dose intensity and missed doses of asparaginase and its effect on relapse and outcomes in patients with ALL receiving multiagent asparaginase-containing chemotherapy
- Identify common immune and nonimmune toxicities associated with asparaginase therapy and their respective risk factors
- Apply evidence-based strategies for managing asparaginase-induced toxicities, including hepatotoxicity and pancreatitis
- Implement pediatric-inspired asparaginase regimens in multiagent chemotherapy and blinatumomab-containing treatment plans for adult and adolescent and young adult (AYA) populations based on evolving clinical evidence and recent guidance
Topics include:
Role of Asparaginase in ALL/LBL
Asparaginase Based Therapy and Immunotherapy
Asparaginase Substitution: Clinical Decision-Making
Pediatric Inspired Regimens in AYA Patients
Asparaginase Toxicities
Monitoring and managing Asparaginase Toxicities
Therapeutic Drug Monitoring
Case: Hypersensitivity in receiving asparaginase-based therapy
Case: Silent inactivation in receiving asparaginase-based therapy
Provided by The University of Chicago Pritzker School of Medicine and the Academy for Continued Healthcare Learning (ACHL).
This program is supported by an independent medical education grant from Jazz Pharmaceuticals
Mitchell S. Cairo, MD
Chief, Pediatric Hematology, Oncology, and Stem Cell Transplantation
Director, Children and Adolescent Cancer and Blood Diseases Center
Medical and Scientific Director, WMC Cellular and Tissue Engineering Laboratory
Medical Director, WMC Hematotherapy Program
Vice Chairman of Pediatrics
Professor of Pediatrics, Medicine, Pathology, Microbiology
& Immunology and Cell Biology & Anatomy
Maria Fareri Children’s Hospital
Westchester Medical Center (WMC)
New York Medical College
New York, NY
Chief, Pediatric Hematology, Oncology, and Stem Cell Transplantation
Director, Children and Adolescent Cancer and Blood Diseases Center
Medical and Scientific Director, WMC Cellular and Tissue Engineering Laboratory
Medical Director, WMC Hematotherapy Program
Vice Chairman of Pediatrics
Professor of Pediatrics, Medicine, Pathology, Microbiology
& Immunology and Cell Biology & Anatomy
Maria Fareri Children’s Hospital
Westchester Medical Center (WMC)
New York Medical College
New York, NY
Wendy Stock, MD
Professor of Medicine
The University of Chicago
Chicago, IL
Emily E. Dworkin, PharmD, BCOP
Clinical Pharmacist Specialist - Hematology/Oncology
UChicago Medicine
Chicago, IL
As a provider accredited by the ACCME, The University of Chicago Pritzker School of Medicine asks everyone in a position to control the content of an education activity to disclose all financial relationships with any ineligible companies. This includes any entity whose primary business is producing, marketing, selling, re-selling, or distributing healthcare products used by or on patients. Financial relationships are relevant if a financial relationship, in any amount, exists between the person in control of content and an ineligible company during the past 24 months, and the content of the education is related to the products of an ineligible company with whom the person has a financial relationship. Mechanisms are in place to identify and mitigate any relevant financial relationships prior to the start of the activity.
Additionally, The University of Chicago Pritzker School of Medicine requires Authors to identify investigational products or off-label uses of products regulated by the US Food and Drug Administration at first mention and where appropriate in the content.
The following financial relationships have been provided:
Mitchell S. Cairo, MD
No financial relationships to disclose
Wendy Stock, MD
No financial relationships to disclose
Emily E. Dworkin, PharmD, BCOP
No financial relationships to disclose
The University of Chicago Pritzker School of Medicine, ACHL staff members and others involved with the planning, development, and review of the content for this activity have no relevant affiliations or financial relationships to disclose.
All of the relevant financial relationships listed for these individuals have been mitigated.
To receive credit, learners are required to complete the pretest, view the online activity, and complete the posttest and evaluation. To receive credit, 80% must be achieved on the posttest. A certificate will be immediately available. There is no fee to participate in the activity or for the generation of the certificate.
For questions, contact Karen Catino at kcatino@achlcme.org
The University of Chicago Pritzker School of Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.The University of Chicago Pritzker School of Medicine designates this enduring material for a maximum of 1.0 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Learners are encouraged to contact their licensing or specialty board to confirm that participation in this activity will count toward any continuing education requirements. This certificate includes information regarding the credit designation of this activity. This may be presented to a licensing board as evidence or documentation of participation at a bona fide continuing education activity. ACHL makes its best efforts to offer CE credit or contact hours to identified members of the target audience. However, ACHL does not guarantee that any certificate will be accepted.
Physician assistants, nurse practitioners, and nurses may participate in this educational activity and earn a certificate of completion as AAPA, AANP, and ANCC accept AMA PRA Category 1 Credits™ through their reciprocity agreements.
The Academy for Continued Healthcare Learning is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education. This activity has been approved for 1.0 contact hours.
ACPE Universal Activity Number:
Activity Type: Application 0396-0000-26-017-H99-P
Release Date: October 7, 2026
Expiration Date: October 7, 2027
CPE credit will be submitted to CPE Monitor® on the first business day of each month.
