Building Clinical Capacity for Optimal Asparaginase-Based Treatment in Acute Lymphoblastic Leukemia and Lymphoblastic Lymphoma: Approaches in Pediatric, Adult, and Adolescent and Young Adult Patients

Asparaginase is a cornerstone of regimens for acute lymphoblastic leukemia (ALL) and lymphoblastic lymphoma (LBL) in pediatric and adult patients. Asparaginase-based therapy is frequently complicated by a distinct spectrum of toxicities, including hypersensitivity reactions, hepatotoxicity, thrombotic events, and pancreatitis, which pose significant clinical management challenges. Further, hypersensitivity and silent inactivation can result in diminished therapeutic effectiveness and poorer outcomes if not appropriately identified and addressed. Novel asparaginase formulations offer alternatives for patients experiencing hypersensitivity to E. coli-derived asparaginase, but these preparations possess distinct pharmacokinetic and immunogenic profiles that necessitate tailored management approaches.
 
The management of ALL/LBL in adolescent and young adults (AYA) is complex, and these patients often have reduced survival due to their unique needs, challenges with transitions of care, and divergent management across different providers and settings. For example, pediatric-inspired regimens improve outcomes in AYA, but adoption has been inconsistent due to logistical complexity, outpatient adherence challenges, and unclear pathways for integrating monitoring and toxicity management into workflows. There is also persistent variability in the implementation of monitoring protocols. To address these challenges, new guidelines specific to the AYA population were recently released.

To mitigate barriers and improve outcomes in patients with ALL/LBL, clinicians can benefit from peer-to-peer exchanges to build confidence, model best practices, and discuss practical strategies to achieve goals.
 
Working collaboratively with an outside expert, clinical teams will participate in a 1-hour learning and action planning program to review and enhance their delivery and monitoring of asparaginase-based therapy across diverse patient populations.
 
Educational Partner: Academy for Continued Healthcare Learning (ACHL)
 
Commercial Supporter: Supported by an educational grant from Jazz Pharmaceuticals

Target Audience

This educational activity is designed for academic and community hematologists/oncologists, oncology pharmacists, advanced practice providers and nurses in hematology practice, and other members of the multidisciplinary team.

Learning Objectives

Upon completion of this activity, participants should be better able to:

  • Describe the pharmacokinetic and immunologic differences among available asparaginase formulations used in acute lymphoblastic leukemia (ALL) and lymphoblastic lymphoma (LBL) treatment
  • Outline strategies for differentiating between clinical hypersensitivity and silent inactivation using therapeutic drug monitoring (TDM) and serum asparaginase activity (SAA) assays
  • Discuss the importance of dose intensity and missed doses of asparaginase and its effect on relapse and outcomes in patients with ALL receiving multiagent asparaginase-containing chemotherapy
  • Identify common immune and nonimmune toxicities associated with asparaginase therapy and their respective risk factors
  • Apply evidence-based strategies for managing asparaginase-induced toxicities, including hepatotoxicity and pancreatitis
  • Implement pediatric-inspired asparaginase regimens in multiagent chemotherapy and blinatumomab-containing treatment plans for adult and adolescent and young adult (AYA) populations based on evolving clinical evidence and recent guidance
Additional information
ACGME/ABMS Core Competencies: 
Patient Care and Procedural Skills
Medical Knowledge
Practice-based Learning and Improvement
Systems-based Practice
For more information, please contact:
CME Coordinator Contact Name: 
Karen Catino
CME Coordinator Contact Email: 
[email protected]
Summary
Activity opens: 
09/15/2026
Activity expires: 
09/15/2027
FACULTY
Mitchell S. Cairo, MD
Chief, Pediatric Hematology, Oncology, and Stem Cell Transplantation
Director, Children and Adolescent Cancer and Blood Diseases Center
Medical and Scientific Director, WMC Cellular and Tissue Engineering Laboratory
Medical Director, WMC Hematotherapy Program
Vice Chairman of Pediatrics
Professor of Pediatrics, Medicine, Pathology, Microbiology & Immunology and Cell Biology & Anatomy
Maria Fareri Children’s Hospital
Westchester Medical Center (WMC)
New York Medical College
New York, NY
 
Wendy Stock, MD
Professor of Medicine
The University of Chicago
Chicago, IL
 
Emily E. Dworkin, PharmD, BCOP
Clinical Pharmacist Specialist - Hematology/Oncology
UChicago Medicine
Chicago, IL

Disclosure Declarations
As a provider accredited by the ACCME, The University of Chicago Pritzker School of Medicine asks everyone in a position to control the content of an education activity to disclose all financial relationships with any ineligible companies. This includes any entity whose primary business is producing, marketing, selling, re-selling, or distributing healthcare products used by or on patients. Financial relationships are relevant if a financial relationship, in any amount, exists between the person in control of content and an ineligible company during the past 24 months, and the content of the education is related to the products of an ineligible company with whom the person has a financial relationship. Mechanisms are in place to identify and mitigate any relevant financial relationships prior to the start of the activity.

Additionally, The University of Chicago Pritzker School of Medicine requires Authors to identify investigational products or off-label uses of products regulated by the US Food and Drug Administration at first mention and where appropriate in the content.
Physician Credit
The University of Chicago Pritzker School of Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.
 
The University Of Chicago Pritzker School Of Medicine designates this enduring activity for a maximum of 1 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Physician assistants, nurse practitioners, and nurses may participate in this educational activity and earn a certificate of completion as AAPA, AANP, and ANCC accept AMA PRA Category 1 Credits™ through their reciprocity agreements.

MIPS logo
Completion of this activity, including the pretest, posttest, and follow-up assessments, qualifies as a medium weight MIPS improvement activity under MACRA and can be claimed as completion of IA_PSPA 28 of an Accredited Safety or Quality Improvement Program in the Quality Payment Program. Clinicians should submit their improvement activities by attestation via the CMS Quality Payment Program website. You will receive additional information after completing the activity and receiving your certificate via email. 
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