Education Spotlight Sessions

Asparaginase in ALL/LBL: Balancing the Risk/Benefit of New Efficacious Preparations

Asparaginase is considered a cornerstone of therapy for acute lymphoblastic leukemia/lymphoblastic lymphoma (ALL/LBL). Since its therapeutic potential was first described in the 1960s, the incorporation of asparaginase into treatment protocols beginning in the mid-1970s was associated with significant improvements in outcomes. Over the past several decades, asparaginase formulations have undergone important advancements. The pegylation of E.coli-derived asparaginase enabled less frequent administration, improving patient convenience. The development of asparaginase from Erwinia chrysanthemi provided a non-cross-reactive alternative for patients who develop hypersensitivity to E. coli asparaginase, allowing them to complete their full treatment course safely. More recently, modification to the PEG linker has resulted in a product with a substantially longer in vivo half-life. The introduction of a recombinant form of Erwinia asparaginase has addressed significant drug shortages associated with the native preparation. Despite these advances, like all anti-cancer drugs, asparaginase preparations are associated with toxicities, many of which are distinct from other agents in patients’ treatment regimen. In this session, we will tackle the complexities of balancing the demonstrated benefits of asparaginases with their unique toxicities.

Dr. Birgitte Klug Albertsen will focus on hypersensitivity reactions to asparaginase. As a foreign protein, asparaginase can illicit an immune response resulting in life-threatening allergic reactions and neutralization of the drug. Dr. Alberten will discuss the incidence and manifestations of antibody-mediated hypersensitivity reactions, the role of therapeutic drug monitoring, and potential means to distinguish antibody-mediated from infusion reactions. She will also discuss management strategies, emphasizing when it is necessary to switch from E. coli-derived to Erwinia-derived asparaginase.

Dr. Marlise Luskin will review the spectrum of other adverse events that can occur with asparaginase, including pancreatitis, hyperglycemia, hyperlipidemia, and thromboses. Dr. Luskin will highlight known risk factors for specific toxicities such as age and obesity and discuss potential prevention strategies and management approaches. Additionally, Dr. Luskin will address criteria for safely rechallenging patients with asparaginase following toxicity.

Chair:

Rachel E. Rau, MD
Seattle Children's Hospital
Seattle, WA, United States

Speakers:

Birgitte Klug Albertsen Sr, MD, PhD
Aarhus University Hospital and Aarhus University
Aarhus, Central Denmark Region, Denmark
Asparaginase Hypersensitivity Incidence, Manifestations, and Management

Marlise Rachael Luskin, MD, MSCE
Dana-Farber Cancer Institute
Boston, MA, United States
Beyond Hypersensitivity: The Gamut of Other Asparaginase Associated Toxicities

How to Prevent and Manage Infections in Immunocompromised Patients in the Era of Immunotherapy and Growing Antibiotic Resistance

Infectious complications remain one of the most important problems in immunocompromised patients, especially after cellular therapy. Risk factors influencing infection development and outcome are discussed with strategies to prevent, monitor, and manage infections in the population of patients undergoing treatment with modern immunotherapy 

Chair:

Lidia Gil
University of Medical Sciences
Poznan, Poland

Speakers:

Randy Taplitz
City of Hope National Medical Center
Duarte, CA, United States
Measures to Minimize Infection Risk in Immunocompromised Patients after Cellular Therapies - How, for Whom, for How Long?

Miguel-Angel Perales, MD
Memorial Sloan Kettering Cancer Center
New York, NY, United States
Protection Without Complete Disruption (of the microbiome): Management of Febrile Neutropenia in Immunocompromised Patients in 2025

Joint Session with ASPHO: Transition to Adult Care in Malignant and Classical Hematology

This session will address strategies for successful transition from pediatric to adult care in sickle cell disease (SCD), an area of increasing importance with the availability of gene therapies and bone marrow transplant. We will learn from models of successful transition in leukemia/lymphoma survivors and how this may inform potential approaches in SCD.

Dr. Jerlym Porter will explore the complexities of defining what constitutes a "successful transition" from pediatric to adult care in individuals with SCD. Without a consensus definition of transition success, efforts to evaluate predictors of success or the effectiveness of transition interventions remain limited. We will examine current transition outcomes, highlight the limitations of existing metrics, and propose a roadmap for future transition research. This framework aims to support the sustainability, scalability, and equity of transition programs for individuals with SCD.

Following treatment for leukemia or lymphoma during childhood and adolescence, continuation of age-appropriate survivorship care across the lifespan is recommended for detection of late effects, medical monitoring, and promotion of physical health and psychosocial well-being. Accomplishing this requires a smooth handoff of survivorship care from the pediatric treatment center to suitable adult-focused clinicians and settings. However, this process is fraught with challenges and is often unsuccessful. In this presentation, Dr. Freyer will review the rationale for survivorship care transition, discuss common barriers and facilitators, and compare current models of transitional care — emphasizing that the "best" model is one that incorporates important core elements but is adapted to local circumstances.

Chair:

Deepa Manwani
St. Jude Children's Research Hospital
Memphis, TN, United States

Speakers:

Jerlym Porter, PhD, MPH
St. Jude Children's Research Hospital
Memphis, TN, United States
Quality after Quality Improvement Projects for Improved Transition: Lessons Learned in Sustainability and Predictors of Success

David Robert Freyer, DO
Children's Hospital Los Angeles
Los Angeles, CA, United States
Models and Importance of Successful Transition in Leukemia/Lymphoma Survivors

The Changing Face of Chronic Myelogenous Leukemia

Chronic myelogenous leukemia management has evolved significantly over the past two decades with the approval and development of multiple tyrosine kinase inhibitors (TKIs) including ATP binding site TKIs and, recently, the approval of a myristoyl pocket inhibitor, asciminib. The recent approval of asciminib in the upfront setting continues to change the treatment paradigm for this disease. However, questions remain regarding TKI selection in the upfront setting and beyond. Investigation is ongoing focusing on questions surrounding TKI selection, and strategies evaluating combination therapy are emerging. Dr. Jorge Cortes will discuss current recommendations for frontline treatment selection and Dr. Francois-Xavier Mahon will discuss current data around treatment-free remissions and other TKI management strategies, focusing on the management of long-term, TKI-related toxicities (in adult and pediatric patients). Of note, the speakers will ensure that the pediatric perspective is incorporated as well.

Chair:

Gabriela Soriano Hobbs, MD
Massachusetts General Hospital
Boston, MA, United States

Speakers:

Jorge Cortes, MD
Georgia Cancer Center at Augusta University
Augusta, SC, United States
Frontline Treatment Selection for CML in 2025

Francois-Xavier Mahon
Institut Bergonié and Bordeaux university
Bordeaux, Nouvelle Aquitaine, France
Can I Stop Taking My TKI Yet?

Transfusion Medicine for Practicing Hematologists: How to Prevent and Treat Potentially Fatal Reactions in Sickle Cell Disease

Over the decades, due to advances in infectious disease testing, blood and blood component transfusions have become remarkably safe; however, non-infectious complications remain a concern. Some of these complications are uncommon and may, therefore, be overlooked in clinical practice. This session will focus on some of these uncommon but potentially fatal complications seen in patients with sickle cell anemia (SCA), many of whom are transfusion dependent.     

Dr. Chou will review the role of genetic testing in SCA, where red blood cell (RBC) transfusions are a critical, often lifesaving therapy. However, this population faces a disproportionately high risk of alloimmunization, leading to serious complications such as delayed hemolytic transfusion reactions (DHTRs). In this session, she will explore clinical case studies that illustrate how molecular technologies can be used to reduce alloimmunization and DHTR risk. She will also discuss strategies for selecting compatible donors for patients with complex alloantibody profiles and how DNA-based matching techniques can enhance transfusion safety and improve clinical outcomes.

Dr. Weiss will discuss hyperhemolysis syndrome (HHS), which is a rare yet critical condition that poses significant risks of morbidity and mortality associated with blood transfusions. Through an examination of several clinical case studies from the transfusion service perspective, attendees will gain insights into the complexities and nuances of HHS. The session will highlight the vital importance of early recognition and accurate diagnosis, with a focus on patient testing within the transfusion service. 

Chair:

Ravindra Sarode, MD
University of Texas Southwestern Medical Center
Dallas, TX, United States

Speakers:

Stella T Chou, MD
Children's Hospital of Philadelphia
Philadelphia, PA, United States
Incorporation of Genetics into Transfusion Medicine Therapy

Susan Weiss, MD
Atrium Health
Charlotte, NC, United States
Hyperhemolysis Syndrome: A Frequently Overlooked Yet Deadly Transfusion Complication