L-asparaginase is a key drug in the treatment of acute lymphocytic leukemia/lymphoblastic lymphoma and is currently used in treatment regimens for a wide range of age groups, including children, adolescents, young adults, and older adults. Discontinuation of L-asparaginase leads to worse survival outcomes. Strategies such as appropriate prevention and management of asparaginase-specific adverse events such as hypersensitivity reactions and optimizing administration by therapeutic drug monitoring are important to ensure completion of all asparaginase doses planned in each regimen. Two new L-asparaginase preparations with different properties are now available in Japan, and attempts to leverage these properties for more effective and safe administration are attracting attention. This article reviews previous advances in therapy with L-asparaginase and outlines current and future challenges for maximizing the therapeutic efficacy of L-asparaginase.
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