L‐asparaginase treatment in acute lymphoblastic leukemia |
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Authors: | Rob Pieters MD PhD Stephen P. Hunger MD Joachim Boos MD Carmelo Rizzari MD Lewis Silverman MD Andre Baruchel MD Nicola Goekbuget MD Martin Schrappe MD Ching‐Hon Pui MD |
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Affiliation: | 1. Erasmus MC‐Sophia Children's Hospital, Rotterdam, NetherlandsFax: (011) 0031‐(0)10‐703‐6801;2. The Department of Pediatrics, University of Colorado, Denver School of Medicine and the Children's Hospital, Aurora, Colorado;3. University Children's Hospital Münster, Department of Pediatric Hematology and Oncology, Münster, Germany;4. Department of Pediatrics, University of Milano‐Bicocca, Hospital S Gerardo, Monza, Italy;5. Department of Pediatric Oncology, Dana‐Farber Cancer Institute/Children's Hospital Boston, Boston, Massachusetts;6. Hospital Saint‐Louis and Robert Debré AP‐HP, University Paris Diderot, Paris, France;7. J.W. Goethe University Hospital, Department of Internal Medicine II, Frankfurt, Germany;8. Department of General Pediatrics, University Medical Center Schleswig‐Holstein, Kiel, Germany;9. Department of Oncology, St Jude Children's Research Hospital and the University of Tennessee Health Science Center, Memphis, TennesseeTelephone: 901‐595‐3300 |
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Abstract: | Asparaginases are a cornerstone of treatment protocols for acute lymphoblastic leukemia (ALL) and are used for remission induction and intensification treatment in all pediatric regimens and in the majority of adult treatment protocols. Extensive clinical data have shown that intensive asparaginase treatment improves clinical outcomes in childhood ALL. Three asparaginase preparations are available: the native asparaginase derived from Escherichia coli (E. coli asparaginase), a pegylated form of this enzyme (PEG‐asparaginase), and a product isolated from Erwinia chrysanthemi, ie, Erwinia asparaginase. Clinical hypersensitivity reactions and silent inactivation due to antibodies against E. coli asparaginase, lead to inactivation of E. coli asparaginase in up to 60% of cases. Current treatment protocols include E. coli asparaginase or PEG‐asparaginase for first‐line treatment of ALL. Typically, patients exhibiting sensitivity to one formulation of asparaginase are switched to another to ensure they receive the most efficacious treatment regimen possible. Erwinia asparaginase is used as a second‐ or third‐line treatment in European and US protocols. Despite the universal inclusion of asparaginase in such treatment protocols, debate on the optimal formulation and dosage of these agents continues. This article provides an overview of available evidence for optimal use of Erwinia asparaginase in the treatment of ALL. Cancer 2011. © 2010 American Cancer Society. |
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Keywords: | acute lymphoblastic leukemia asparagine depletion asparaginase Erwinia asparaginase Erwinase ALL |
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