Optimizing Asparaginase Treatment for Adolescent and Young Adult (AYA) Patients With Acute Lymphoblastic Leukemia: US Consensus Panel Recommendations

ABSTRACT Asparaginase is an integral component of therapy for pediatric patients with acute lymphoblastic leukemia/lymphoblastic lymphoma. The success of asparaginase‐containing regimens has led to trials of pediatric/pediatric‐inspired regimens incorporating asparaginase for treating adolescent and young adult (AYA) and adult populations with acute lymphoblastic leukemia/lymphoblastic lymphoma. While treatment of AYA patients with these regimens is associated with improved clinical outcomes compared with adult‐specific protocols, AYA patients face unique challenges with these treatments, further complicated by a rapidly evolving therapeutic landscape. In this article, we identify barriers and other feasibility issues associated with administering asparaginase‐based treatment to AYA patients and provide recommendations from a consensus panel of experts to optimize AYA patient outcomes and experiences. Barriers identified include the limited access to clinical trials and specialized expertise in pediatric‐inspired regimens for AYA patients compared with pediatric patients, the complex management of asparaginase toxicities, limited medical facilities and experienced staff to administer and manage pediatric‐inspired regimens, and reduced AYA patient access/adherence to treatment due to lifestyle‐related or psychosocial challenges. Recommendations are provided on addressing and managing these challenges to improve asparaginase‐based treatment accessibility and safety in AYA patients, including specific recommendations for high‐risk populations. Trial Registration: ClinicalTrials.gov : NCT04817761