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In the Know: Optimized Management of Asparaginase Therapy in Acute Lymphoblastic Leukemia
***Pre-assessment***

Before you view the Expert Roundtable, please take this pre-assessment. Taking this pre-assessment does not immediately qualify learners to earn credit. 

Certificates of credit will only be sent to learners who also receive a passing score on the post-test (separate from this survey), and fill out the evaluation form and application for credit.
1.What are your credentials? (Required.)
2.What is your specialty?
3.How confident are you in the management of patients with ALL in your practice?
Very confident
Confident
Neutral
Little confidence
No confidence
4.Based on multivariable analysis of the Children’s Oncology Group (COG) Protocols (AALL0331 and AALL0232), nonadherence to all doses of asparaginase therapy contributed to which of the following outcomes in children with acute lymphoblastic leukemia (ALL)?(Required.)
5.SK is an 11-year-old female who presents on day 6 of induction therapy with the COG protocol AALL0232 for high-risk ALL. She began her intravenous pegaspargase infusion about 30 minutes ago and now has flushing, nausea and vomiting. Her blood pressure is 88/65 mmHg. Her pegaspargase dose has been held, antiemetics administered and she was given a fluid bolus with improvement in blood pressure.

Which of the following is most appropriate for SK at this time?(Required.)
6.AP is a 26-year-old female diagnosed with B-cell ALL. She was induced according to a pediatric-inspired regimen and received 2000 IU/m2 pegaspargase on day 15. Direct bilirubin started to increase 1 week post-pegaspargase and peaked 1 week later at 5 mg/dL (grade 3 toxicity). After 4 weeks, the bilirubin had gradually declined spontaneously to grade 1. She achieved a complete response, minimal residual disease negative. 

Which of the following is most appropriate regarding future doses of asparaginase?(Required.)
7.MM is a 19-year-old male who presents on day 43 of consolidation on CALGB 10403 for ALL. Two hours after completing his IV pegaspargase (PEG-asp) infusion he developed diaphoresis, wheezing and stridor.  A serum asparaginase activity level 7 days later was < 0.01 IU/mL.

Which of the following is most appropriate for MM’s subsequent therapy? (Required.)
8.Which of the following best describes how asparaginase erwinia chrysanthemi (recombinant)-rywn (ERW-rywn) differs from asparaginase erwinia chrysanthemi (ERW)?(Required.)
9.Please let us know who you are so we can connect your responses to your post-test & application to claim CME credit (completed after participating in the activity) 
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