Increasing completion of asparaginase treatment in childhood acute lymphoblastic leukaemia (ALL): summary of an expert panel discussion
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 ce...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2020-10-01
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| Series: | ESMO Open |
| Online Access: | https://esmoopen.bmj.com/content/5/5/e000977.full |
| _version_ | 1819290428216705024 |
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| author | Carmelo Rizzari Kjeld Schmiegelow Patrick Brown André Baruchel Lewis Silverman Inge van der Sluis Benjamin Ole Wolthers |
| author_facet | Carmelo Rizzari Kjeld Schmiegelow Patrick Brown André Baruchel Lewis Silverman Inge van der Sluis Benjamin Ole Wolthers |
| author_sort | Carmelo Rizzari |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-12-24T03:22:35Z |
| format | Article |
| id | doaj.art-2a5970c171d14082aee4c4c8892bdd48 |
| institution | Directory Open Access Journal |
| issn | 2059-7029 |
| language | English |
| last_indexed | 2024-12-24T03:22:35Z |
| publishDate | 2020-10-01 |
| publisher | Elsevier |
| record_format | Article |
| series | ESMO Open |
| spelling | doaj.art-2a5970c171d14082aee4c4c8892bdd482022-12-21T17:17:26ZengElsevierESMO Open2059-70292020-10-015510.1136/esmoopen-2020-000977Increasing completion of asparaginase treatment in childhood acute lymphoblastic leukaemia (ALL): summary of an expert panel discussionCarmelo Rizzari0Kjeld Schmiegelow1Patrick Brown2André Baruchel3Lewis Silverman4Inge van der Sluis5Benjamin Ole Wolthers6University of Milan–Bicocca, Milano, Lombardia, Italy4 Department of Pediatrics and Adolescent Medicine, Juliane Marie Center, Rigshospitalet University Hospital, and Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark Johns Hopkins Medicine Sidney Kimmel Comprehensive Cancer Center, Baltimore, Maryland, USAUniversité de Paris, APHP, Hôpital Universitaire Robert-Debré, Paris, FranceDFCI, Boston, Massachusetts, USAPrincess Maxima Center for Pediatric Oncology, Utrecht, Utrecht, NetherlandsJuliane Marie Centre, Kobenhavn, DenmarkInsufficient 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.https://esmoopen.bmj.com/content/5/5/e000977.full |
| spellingShingle | Carmelo Rizzari Kjeld Schmiegelow Patrick Brown André Baruchel Lewis Silverman Inge van der Sluis Benjamin Ole Wolthers Increasing completion of asparaginase treatment in childhood acute lymphoblastic leukaemia (ALL): summary of an expert panel discussion ESMO Open |
| title | Increasing completion of asparaginase treatment in childhood acute lymphoblastic leukaemia (ALL): summary of an expert panel discussion |
| title_full | Increasing completion of asparaginase treatment in childhood acute lymphoblastic leukaemia (ALL): summary of an expert panel discussion |
| title_fullStr | Increasing completion of asparaginase treatment in childhood acute lymphoblastic leukaemia (ALL): summary of an expert panel discussion |
| title_full_unstemmed | Increasing completion of asparaginase treatment in childhood acute lymphoblastic leukaemia (ALL): summary of an expert panel discussion |
| title_short | Increasing completion of asparaginase treatment in childhood acute lymphoblastic leukaemia (ALL): summary of an expert panel discussion |
| title_sort | increasing completion of asparaginase treatment in childhood acute lymphoblastic leukaemia all summary of an expert panel discussion |
| url | https://esmoopen.bmj.com/content/5/5/e000977.full |
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