In order to receive credit for this activity, you must read the front matter, view the activity, achieve a passing score of at least 75% on this post-survey, as well as complete the evaluation and application for credit form. Certificates of credit will be emailed to participants who have successfully met these requirements. 

There is no fee to participate in this activity.

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* 1. What are your credentials?

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* 2. What is your area of specialty? 

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* 3. How many years have you been in practice?

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* 4. Please select the option that best describes your practice setting:

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* 5. Of the patients you will see in the next month, about how many will benefit from the information you learned today?

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* 6. After participating in this activity, how confident are you in the management of patients with ALL in your practice?

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* 7. 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)?

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* 8. 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?

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* 9. 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?

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* 10. 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? 

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* 11. Which of the following best describes how asparaginase erwinia chrysanthemi (recombinant)-rywn (ERW-rywn) differs from asparaginase erwinia chrysanthemi (ERW)?

Evaluation Form
In order to receive a CME/CE certificate for your participation in this activity, please complete this form in its entirety.

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* 12. How committed are you to making changes in your practice based on your participation in this activity?

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* 13. Which of the following best describes the impact of this activity on your performance?

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* 14. Which new strategies/skills/information will you apply to your area of practice?

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* 15. What barriers do you see to making changes in your practice?

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* 16. After participating in today’s activity, I am now better able to:

  Strongly agree Agree Neutral Disagree Strongly disagree
Articulate the significance of nonadherence to the dosing of asparaginase in the management of acute lymphoblastic leukemia
Based on patient specific factors and clinical guidelines, discern when a patient should permanently discontinue, temporarily hold, or continue with pegaspargase, or change to an Erwinia asparaginase product 
Distinguish between allergic and nonallergic infusion reactions and determine if there is a need to switch to an Erwinia asparaginase product
Compare asparaginase erwinia chrysanthemi (recombinant)-rywn (ERW-rywn) with asparaginase erwinia chrysanthemi (ERW) based on efficacy, toxicity, manufacturing, dosing and administration

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* 17. The following faculty presenter effectively presented the material: 

  Strongly agree Agree Neutral Disagree Strongly disagree
Ryan D. Cassaday, MD
Lori Muffly MD, MS
Luke Maese, DO

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* 18. The content presented:

  Strongly agree Agree Neutral Disagree Strongly disagree
Enhanced my current knowledge base
Addressed my most pressing questions
Promoted improvements or quality in health care
Was scientifically rigorous and evidence based
Avoided commercial bias or influence

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* 19. If you indicated that you perceived commercial bias or influence, please describe:

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* 20. As a result of your participation in this activity, what is the one change you are most likely to implement in your practice?

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* 21. Please list any clinical issues/problems within your scope of practice you would like to see addressed in future educational activities for this or related ALL:

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* 22. Please let us know who you are so we can connect your responses to your pre-test & application to claim CME credit.

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* 23. I certify that I have participated in the continuing education activity entitled, “In the Know: Optimized Management of Asparaginase Therapy in ALL" and claim 1.0 AMA PRA Category 1 CreditTM.

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