Clinical Resources and Literature Reviews for Managing Asparaginase in AYA ALL/LBL Patients

The Treatment of ALL/LBL in Adolescent and Young Adults (AYA) educational slide deck is designed for healthcare professionals managing Adolescent and Young Adult (AYA) patients with ALL and LBL. It provides an overview of current treatment strategies, clinical evidence, and best practices to optimize outcomes in this unique population. Key topics include:

• Overview of ALL/LBL and epidemiology
• Patient and treatment related challenges in AYA ALL/LBL
• AYA regimens and the role of pediatric-inspired treatment (CALGB 10403 findings)
• The importance of treatment adherence with asparaginase therapy
• Management and prevention of toxicities and adverse events

The deck aims to enhance understanding of treatment paradigms, improve regimen completion, and support evidence-based decision-making to maximize survival outcomes in AYA patients.

(Aldoss, et al. AJH 2025)

• Asparaginase remains a critical component of therapy for AYA patients with Acute Lymphoblastic Leukemia (ALL) and Lymphoblastic Lymphoma (LBL), demonstrating superior clinical outcomes compared to adult-specific regimens.
• Adolescent and Young Adult (AYA) patients encounter unique challenges with asparaginase-based treatments, including issues related to access, toxicity management, and regimen completion.
• This expert panel provides targeted recommendations to address these challenges, aiming to enhance treatment safety, accessibility, and adherence to improve completion of asparaginase and improve survival in AYA patients.

(Stock, et al. Blood 2019)

• This study demonstrated that an intensive pediatric-inspired regimen for Adolescent and Young Adult (AYA) patients with Acute Lymphoblastic Leukemia (ALL) is feasible and yields superior median event-free survival (EFS) and 3-year overall survival (OS) compared to historical controls.
• Based on these findings, CALGB 10403 has emerged as a standard of care for AYAs with ALL, serving as a foundational regimen to further improve survival outcomes in this population.

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For additional information related to AYA ALL/LBL, please see the linked papers below:

• ASH Clinical Practice Guidelines on Acute Lymphoblastic Leukemia in Adolescents and Young Adults: https://www.hematology.org/education/clinicians/guidelines-and-quality-care/clinical-practice-guidelines/acute-lymphoblastic-leukemia-guidelines
• The integration of blinatumomab consolidation in the CALGB 10403 regimen for adults with B-cell precursor acute lymphoblastic leukemia in measurable residual disease-negative remission (Tinajero, et al. BJH 2025): https://doi.org/10.1111/bjh.20200
• Recombinant Erwinia asparaginase (JZP458) in ALL/LBL: complete follow-up of the Children’s Oncology Group AALL1931 study (Maese, et al. Blood Adv 2025): https://doi.org/10.1182/bloodadvances.2024013346
• The Efficacy of Pediatric-Inspired Regimens vs. Hyper-CVAD in the Treatment of Adolescents and Young Adults with Acute Lymphoblastic Leukemia: A Systematic Review and Meta-Analysis (Su, et al. AJH 2025): https://doi.org/10.1002/ajh.27607
• The impact of early PEG-asparaginase discontinuation in young adults with ALL: a post hoc analysis of the CALGB 10403 study (Aldoss, et al. Blood Adv 2023): https://doi.org/10.1182/bloodadvances.2022007791
• Impact of Asparaginase Discontinuation on Outcome in Childhood Acute Lymphoblastic Leukemia: A Report from the Children’s Oncology Group (Gupta, et al. JCO 2020): https://doi.org/10.1200/JCO.19.03024
• Blinatumomab in Standard-Risk B-Cell Acute Lymphoblastic Leukemia in Children (Gupta, et al. N Engl J Med 2024): https://www.nejm.org/doi/10.1056/NEJMoa2411680