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?
For patients not on study, would you consider replacing missed doses of peg with a non-asparaginase based chemotherapy?
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When re-challenging with PEG-asparaginase in a patient who previously had PEG-associated pancreatitis, how do you monitor for recurrence of pancreatitis?
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2 Answers
Mednet MemberInvited Expert
Pediatric Hematology/Oncology · Seattle Children's Hospital, University of Washington
Answered on
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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Mednet MemberInvited Expert
Pediatric Hematology/Oncology · Children’s Wisconsin
Answered on
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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