Optimizing safety and efficacy of asparaginase and blinatumomab therapy in frontline acute lymphoblastic leukemia regimens in diverse health care settings—international expert consensus

Frontline blinatumomab combined with chemotherapy has resulted in improved outcomes in both pediatric and adult patients with acute lymphoblastic leukemia and is considered the new cornerstone of acute lymphoblastic leukemia treatment. The role of asparaginase in this new landscape of acute lymphoblastic leukemia treatment was extensively discussed by an expert panel of hemato-oncologists to reach a consensus on the safety and efficacy of asparaginase in diverse settings with and without blinatumomab. Herein, the following consensus topics are presented: (1) optimal dosing of asparaginase and therapeutic drug monitoring; (2) prevention of asparaginase hypersensitivity reactions and inactivation; (3) integration of frontline blinatumomab, asparaginase, and antimetabolites; and (4) special issues of asparaginase formulations and adaptations for resource-limited settings.