Navigating Asparaginase Treatment for Patients With Acute Lymphoblastic Leukemia: US Consensus Panel Recommendations...

Asparaginase is a critical treatment component for patients with acute lymphoblastic leukemia/lymphoblastic lymphoma (ALL/LBL). However, the successful delivery of asparaginase-based therapy remains challenging across care settings due to its complex administration, distinct toxicity profile, prolonged treatment duration, and the need for coordinated multidisciplinary care. These challenges are further compounded by variability in institutional infrastructure, provider experience, and access to specialized supportive services. In this article, we describe key operational and clinical barriers to the safe, timely, and complete delivery of asparaginase therapy for patients with ALL/LBL and present recommendations developed using a modified Delphi process incorporating literature review and expert consensus. We provide practical recommendations organized across three core areas: (1) defining essential members of the specialized care team and outlining the necessary infrastructure for safe and effective asparaginase administration; (2) identifying key steps in the asparaginase treatment journey for ALL/LBL patients and providing recommendations for successful patient navigation and improved outcomes; and (3) sharing practical resources and solutions used by pharmacists, advanced practice providers, and nurses to optimize asparaginase delivery and ensure treatment completion. These recommendations are intended to provide actionable guidance to harmonize multidisciplinary efforts, minimize avoidable treatment interruptions, and support completion of planned asparaginase therapy. Broad implementation across specialized and nonspecialized centers may improve treatment adherence, mitigate toxicity-related discontinuation, and ultimately optimize outcomes for patients with ALL/LBL receiving asparaginase.