In a patient with HR B ALL and severe pancreatitis due to peg-asparaginase, how do you assess the impact of peg discontinuation on risk of relapse?  

We know from Gupta et al., PMID 32275469 that omission of asparaginase courses from a mBFM chemotherapy backbone has an adverse prognostic impact among NCI HR patients. In fact, complete discontinuation of asparaginase was associated with a 50% increased risk of an event among HR patients. Thus, whe...

Grade 3-4 pancreatitis is considered an indication to withhold future doses of asparaginase of any form. Discontinuation of asparaginase doses is associated with inferior disease free survival in higher-risk pediatric patients with B lymphoblastic leukemia. These results seem less applicable to stan...