Dr Maese on Asparaginase-Based Regimens in Adult/Young Adult ALL

“Significant adverse effects [with asparaginase] for adult and young adult patients with ALL include hepatotoxicity, pancreatitis, and thrombosis. There are data [that indicate] that liver toxicity may be higher in these older patients compared with younger patients, although it may depend on body habitus and demographic factors such as ethnicity.”

Luke Maese, DO, an associate professor on the Clinical Track in the Division of Pediatric Hematology/Oncology at the University of Utah School of Medicine; director of the pediatric Leukemia/Lymphoma and pediatric Cancer Genetics programs; director of the Clinical Trial Research Enterprise and co-director of the Bone Marrow Failure Program at Primary Children’s Hospital; and a member of the Family Cancer Assessment Clinic and Schiffman lab at Huntsman Cancer Institute, discussed treatment considerations for the use of asparaginase-containing regimens for the treatment of adult and young adult patients with acute lymphoblastic leukemia (ALL).

Asparaginase is an important component of treatment protocols for pediatric patients with ALL and has been incorporated into treatment regimens for these patients since the 1970s, Maese began. However, there was hesitancy to adopt the agent in the young adult patient population due to adverse effects (AEs) such as allergic and infusion-related reactions, as well as hypersensitivity toxicities, he added. Although these AEs are not as frequently observed in adult and young adult patients, they are still of concern, he noted.

More common AEs in the adult and young adult patient population include hepatotoxicity, pancreatitis, and thrombosis, Maese emphasized. Although these toxicities are more common in this patient population, their instance and severity can depend on patient characteristics such as body habitus and ethnicity, he said.

Maese noted that investigators have largely been unable to identify which patients are at the highest risk of pancreatitis following treatment with asparaginase. This can be an AE of significance, especially in patients with ALL who often have other comorbidities.

Thrombosis, another commonly observed AE, can be largely well managed with available and novel agents, Maese said. However, hepatotoxicity and thrombosis still contribute to hesitancy surrounding the use of asparaginase in adult and young adult patients with ALL, he concluded.