ASPG and osteonecrosis: To better understand these clinical outcomes, our group previously demonstrated discontinuous dexamethasone has equivalent antileukemic efficacy to continuous dexamethasone in both murine models of leukemia and patient derived xenografts of pediatric ALL.[16] We also demonstrated asparaginase added to continuous dexamethasone increases the rate of osteonecrosis in preclinical models.[17] However, it remains unclear whether asparaginase added to the less osteonecrotic[13, 18] and more clinically relevant discontinuous dexamethasone regimen will alter the rate of osteonecrosis.