In a patient with HR B ALL and severe pancreatitis due to peg-asparaginase, how do you assess the impact of peg discontinuation on risk of relapse?

Topics: Hematologic Malignancies • Pediatric Oncology • Medical Oncology • Leukemia • ALL • AYA • Chemotherapy • Cancer-related Side Effects • COG

For patients not on study, would you consider replacing missed doses of peg with a non-asparaginase based chemotherapy?

Answer from: at Academic Institution

We know from Gupta et al., PMID 32275469 that omission of asparaginase courses from a mBFM chemotherapy backbone has an adverse prognostic impact among NCI HR patients. In fact, complete discontinuation of asparaginase was associated with a 50% increased risk of an event among HR patients. Thus, whe...

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at Ann & Robert H. Lurie Children’s Hospital of Chicago
Thank you Dr. @Rachel Rau for this very thoughtful...

Answer from: at Community Practice

Grade 3-4 pancreatitis is considered an indication to withhold future doses of asparaginase of any form. Discontinuation of asparaginase doses is associated with inferior disease free survival in higher-risk pediatric patients with B lymphoblastic leukemia. These results seem less applicable to stan...

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Thank you Dr. @Paul Harker-Murray, this is helpful...

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