Asparaginase exposure was associated with decreased clearance and increased exposure of dexamethasone,[13] and the development of an antibody response against asparaginase is associated with a decreased incidence of symptomatic osteonecrosis.[14] Recent ALL trials showed that additional doses of asparaginase during interim maintenance therapy caused more osteonecrosis in patients receiving prednisone.[15, 16] Moreover, the hypoalbuminemia caused by asparaginase was also associated with osteonecrosis risk.[3]. This evidence concerns the gene ASPG and Hypoalbuminemia.