Patients First: Navigating Asparaginase-Based Treatment in Young Adults With ALL Pre-activity self-assessment Survey

1.Which of the following treatment strategies is most consistent with contemporary guideline-based care for adolescents and young adults (AYAs) with acute lymphoblastic leukemia (ALL)?

A. Hyperfractionated cyclophosphamide, vincristine, doxorubicin, and dexamethasone alternating with methotrexate and cytarabine (hyper-CVAD)

B. Pediatric-inspired regimen with high cumulative doses of asparaginase, vincristine, and glucocorticoids

C. Short-course anthracycline-based chemotherapy followed by early allogeneic hematopoietic stem cell transplantation

D. Vincristine, prednisone, and cyclophosphamide–based induction followed by maintenance without central nervous system prophylaxis

2.A 30-year-old woman with Philadelphia chromosome–negative B-cell ALL is receiving pegaspargase as part of her treatment regimen. She develops nausea, hypotension, and diffuse skin erythema and pruritus within minutes of starting her second pegaspargase infusion. The symptoms resolve after the infusion is stopped, and she is treated with intravenous fluids, diphenhydramine, and dexamethasone. Which of the following is the most appropriate next step in the management of her asparaginase therapy?

A. Deliver the next dose of pegaspargase at a slower infusion rate after premedication

B. Discontinue pegaspargase permanently without substitution

C. Switch to calaspargase pegol for subsequent doses

D. Switch to recombinant Erwinia-derived asparaginase for subsequent doses

3.In AYAs with ALL treated with pediatric-inspired asparaginase-based protocols, early discontinuation of asparaginase has been associated with which of the following outcomes?

A. Sufficient and prolonged serum asparaginase depletion

B. No significant impact on survival if at least 50% of planned doses are given

C. Inferior disease-free and/or overall survival compared with patients who complete the planned course

D. Improved tolerability and similar disease-free and overall survival

4.A 26-year-old man with Philadelphia chromosome–negative B-cell ALL on a pediatric-inspired regimen that includes E coli–derived asparaginase is found to have a trough serum asparaginase activity (SAA) level of 0.05 IU/mL on day 7 after dosing, without any clinical symptoms. Repeat testing confirms an SAA level of 0.05 IU/mL. Which of the following best describes this situation and its recommended management?

A. Therapeutic SAA level; continue the same drug and schedule

B. Silent inactivation; switch from E coli–derived asparaginase to Erwinia-derived asparaginase

C. Expected pharmacokinetics; increase the dose of E coli–derived asparaginase by 50%

D. Benign laboratory variation; repeat SAA level in 2 weeks without changing therapy

5.A 35-year-old man with obesity and ALL receiving pegaspargase develops grade 3 hyperbilirubinemia and grade 3 elevation in AST and ALT liver enzymes. He is otherwise clinically stable. Which of the following reflects the recommended approach to his asparaginase therapy?

A. Hold further pegaspargase and delay subsequent cycles until liver test results improve, then consider resuming with dose or schedule modification

B. Permanently discontinue all asparaginase therapy because hepatotoxicity is a contraindication to rechallenge

C. Continue full-dose pegaspargase and add prophylactic cryoprecipitate to reduce the risk of bleeding associated with low fibrinogen levels

D. Switch to Erwinia-derived asparaginase, which is not associated with hepatotoxicity

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