Improving Your Clinical Acumen in ALL: Focus on Asparaginase - prIME Oncology
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prIME Case

Improving Your Clinical Acumen in ALL: Focus on Asparaginase

A Case-Based Educational Series: Case One of Three

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prIME Oncology virtual eCases deliver concise, interactive clinical scenarios along with data to support different decision points along the patient’s disease course.

This case focuses on the use of pediatric-inspired protocols for treating adolescent/young adult (AYA) patients with acute lymphoblastic lymphoma (ALL) and the optimal approaches to testing and interpretation of minimal residual disease.

Interactive Presentation

Interactive Presentation



0.5 AMA PRA Category 1 Credit

Release Date

Release Date

Jul 30, 2018

Expiration Date

Jul 30, 2019

Your patient is a 21-year-old woman with an unremarkable medical history who presented to the emergency room with fatigue and menorrhagia. Initial laboratory tests revealed a white blood cell count of 16×109/L, hemoglobin count of 5.1 g/dL, and platelet count of 15×109/L. Bone marrow (BM) biopsy and immunophenotype were consistent with precursor B-cell acute lymphoblastic leukemia (ALL) (CD19+, CD10+, CD22+, CD34+, cytoplasmic CD79a+, and TdT+). Karyotyping showed a normal female karyotype. Fluorescence in situ hybridization was negative for BCR-ABL1, MLL rearrangement, ETV5/RUNX1, and trisomies 4, 10, and 17.

  • Eunice Wang, MDRoswell Park Cancer Institute
    Buffalo, New York, United States
  • Amro El-Shoury, MDRoswell Park Cancer Institute
    Buffalo, New York, United States

This activity is designed to meet the educational needs of hematologists, pediatric hematologists, nurses, physician assistants, nurse practitioners, and other healthcare professionals who treat or manage patients with hematologic malignancies.

After successful completion of this educational activity, participants should be able to:

  • Implement pediatric-inspired protocols for treating AYA patients with ALL
  • Identify optimal approaches to minimal residual disease testing and interpretation in managing ALL


  • Asparaginase use in AYA patients with ALL
  • Therapeutic drug monitoring
  • Distinguishing between infusion-related reactions vs hypersensitivity to asparaginase
  • Management of hypersensitivity and silent inactivation
    • Indications for switching asparaginase preparations
    • Monitoring after switching preparations

Improving Skills in Pediatric ALL: Focus on Asparaginase

  • Use of asparaginase in treating pediatric ALL
  • Similarities and differences among available asparaginase preparations

This educational activity is supported by a grant from Shire.

Continuing Education

prIME Oncology is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

prIME Oncology designates this enduring material for a maximum of 0.5 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.


This activity is provided by prIME Oncology.

Disclosure Information

Method of Participation

There are no fees for participating in and receiving CME credit for this activity. In order to receive credit, participants must successfully complete the online posttest and activity evaluation. Your participation in this CME activity will be recorded in prIME Oncology’s database. However, upon request, your CME credit certificate will be emailed to you. Technical requirements may be found under the Terms of Use.

Links to the post-test are available on the video player pages.

In order to receive credit, participants must successfully complete the online posttest with 75% or higher.

Disclosure of Relevant Financial Relationships

prIME Oncology assesses relevant financial relationships with its instructors, planners, managers, and other individuals who are in a position to control the content of CME activities. Any potential conflicts of interest that are identified are thoroughly vetted by prIME Oncology for fairness, balance, and scientific objectivity of data, as well as patient care recommendations. prIME Oncology is committed to providing its learners with high-quality CME activities and related materials that promote improvements or quality in healthcare and not a specific proprietary business interest of a commercial entity.

The faculty reported the following financial relationships or relationships to products or devices they or their spouses/life partners have with commercial interest related to the content of this activity:

Dr El-Shoury has no relevant financial relationships to report. He has agreed to disclose any unlabeled/unapproved uses of drugs or products referenced in his presentation.

Dr Wang has disclosed that she has received consulting fees from AbbVie and Amgen. She has also received honoraria for promotional speaker’s bureaus from Jazz Pharmaceuticals and Novartis. She disclosed membership on advisory committees or review panels for Celyad and Pfizer. She has agreed to disclose any /unapproved uses of drugs or products referenced in her presentation.

The employees of prIME Oncology have disclosed:

  • Ronald Viggiani, MD (medical director content reviewer/planner) – no relevant financial relationships
  • Kristin Tomlinson, PhD (scientific content reviewer/planner) – no relevant financial relationships
  • Heather Tomlinson, ELS (editorial content reviewer) – no relevant financial relationships


Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patients’ conditions and possible contraindications or dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.

Disclosure Regarding Unlabeled Use

This activity may contain discussion of published and/or investigational uses of agents that are not indicated by the US Food and Drug Administration or European Medicines Agency. Please refer to the official prescribing information for each product discussed for discussions of approved indications, contraindications, and warnings.