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Morawiak A, Salamonowicz-Bodzioch M, Królak A, Kałwak K, Owoc-Lempach J, Kowalczyk J, Zawitkowska J, Szczepański T, Irga-Jaworska N, Adamkiewicz-Drożyńska E, Albrecht K, Szmydki-Baran A, Balwierz W, Czogała M, Wachowiak J, Derwich K, Młynarski W, Zalewska-Szewczyk B, Krawczuk-Rybak M, Sawicka-Żukowska M, Styczyński J, Kołtan A, Safranow K, Urasiński T, Ociepa T. Acute Pancreatitis in Pediatric Acute Lymphoblastic Leukemia (AcuPA Study): A Nationwide Survey in Poland. Cancers (Basel) 2024; 16:2640. [PMID: 39123368 PMCID: PMC11312082 DOI: 10.3390/cancers16152640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2024] [Revised: 07/19/2024] [Accepted: 07/23/2024] [Indexed: 08/12/2024] Open
Abstract
PURPOSE This study aimed to identify the risk factors for acute pancreatitis (AP) and its impact on outcomes in Polish children treated for ALL. METHODS The study group included 2303 children receiving intensive chemotherapy for ALL. The group was divided into patients with at least one episode of AP and those who did not develop AP after treatment for ALL. RESULTS The cumulative incidence of AP in the study group was 4.08%. Older age was an independent risk factor for the development of AP (OR = 1.05; 95%CI = 1.006-1.098; p = 0.03). The overall mortality associated with AP was 2.13%. The probabilities of disease-free survival (p-DFS) and event-free survival (p-EFS) in both subgroups were 0.84 vs. 0.86, log-rank p = 0.65 and 0.75 vs. 0.80, log-rank p = 0.12, respectively. A total of 22 out of 94 patients (23.4%) with AP were re-exposed to asparaginase (ASP) during the subsequent treatment phases. Only one patient re-exposed to ASP (4.5%) developed a second episode of AP. There were no significant differences in p-DFS and p-EFS between patients re-exposed and not re-exposed to asparaginase (0.78 vs. 0.86, log-rank p = 0.27 and 0.63 vs. 0.79, log-rank p = 0.09, respectively). CONCLUSIONS The incidence of AP in children with ALL is low and related to patients' age. The development of AP does not seem to influence p-DFS and p-EFS in children with ALL. Recurrence of AP after re-exposure to asparaginase in patients with ALL and a history of AP is low (4.5%). Re-exposure to asparaginase after the first episode of AP does not improve either p-DFS or p-EFS in children with ALL.
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Affiliation(s)
- Anna Morawiak
- Department of Pediatrics, Hemato-Oncology and Gastroenterology, Pomeranian Medical University, Unii Lubelskiej 1, 71-252 Szczecin, Poland; (A.M.); (A.K.); (T.U.)
| | - Małgorzata Salamonowicz-Bodzioch
- Department of Pediatric, Hematology, Oncology and BMT, Wrocław Medical University, 50-367 Wroclaw, Poland; (M.S.-B.); (K.K.); (J.O.-L.)
| | - Aleksandra Królak
- Department of Pediatrics, Hemato-Oncology and Gastroenterology, Pomeranian Medical University, Unii Lubelskiej 1, 71-252 Szczecin, Poland; (A.M.); (A.K.); (T.U.)
| | - Krzysztof Kałwak
- Department of Pediatric, Hematology, Oncology and BMT, Wrocław Medical University, 50-367 Wroclaw, Poland; (M.S.-B.); (K.K.); (J.O.-L.)
| | - Joanna Owoc-Lempach
- Department of Pediatric, Hematology, Oncology and BMT, Wrocław Medical University, 50-367 Wroclaw, Poland; (M.S.-B.); (K.K.); (J.O.-L.)
| | - Jerzy Kowalczyk
- Department of Pediatric Hematology, Oncology and Transplantology, Medical University of Lublin, 20-059 Lublin, Poland; (J.K.); (J.Z.)
| | - Joanna Zawitkowska
- Department of Pediatric Hematology, Oncology and Transplantology, Medical University of Lublin, 20-059 Lublin, Poland; (J.K.); (J.Z.)
| | - Tomasz Szczepański
- Department of Pediatric Hematology and Oncology, Silesian Medical University, 40-055 Zabrze, Poland;
| | - Ninela Irga-Jaworska
- Department of Pediatrics, Hematology and Oncology, Medical University, 80-210 Gdansk, Poland; (N.I.-J.); (E.A.-D.)
| | | | - Katarzyna Albrecht
- Department of Pediatric Hematology and Oncology, Medical University, 02-091 Warszawa, Poland; (K.A.); (A.S.-B.)
| | - Anna Szmydki-Baran
- Department of Pediatric Hematology and Oncology, Medical University, 02-091 Warszawa, Poland; (K.A.); (A.S.-B.)
| | - Walentyna Balwierz
- Department of Pediatric Oncology and Hematology, University Children’s Hospital, Collegium Medicum Jagiellonian University, 31-008 Krakow, Poland; (W.B.); (M.C.)
| | - Małgorzata Czogała
- Department of Pediatric Oncology and Hematology, University Children’s Hospital, Collegium Medicum Jagiellonian University, 31-008 Krakow, Poland; (W.B.); (M.C.)
| | - Jacek Wachowiak
- Department of Pediatric Oncology, Hematology and Transplantology, University of Medical Sciences, 61-701 Poznan, Poland; (J.W.); (K.D.)
| | - Katarzyna Derwich
- Department of Pediatric Oncology, Hematology and Transplantology, University of Medical Sciences, 61-701 Poznan, Poland; (J.W.); (K.D.)
| | - Wojciech Młynarski
- Department of Pediatrics, Hematology and Oncology, Medical University, 90-419 Lodz, Poland; (W.M.); (B.Z.-S.)
| | - Beata Zalewska-Szewczyk
- Department of Pediatrics, Hematology and Oncology, Medical University, 90-419 Lodz, Poland; (W.M.); (B.Z.-S.)
| | - Maryna Krawczuk-Rybak
- Department of Pediatrics, Oncology an Hematology, Medical University, 15-089 Bialystok, Poland; (M.K.-R.); (M.S.-Ż.)
| | - Małgorzata Sawicka-Żukowska
- Department of Pediatrics, Oncology an Hematology, Medical University, 15-089 Bialystok, Poland; (M.K.-R.); (M.S.-Ż.)
| | - Jan Styczyński
- Department of Pediatrics, Hematology and Oncology, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, 87-100 Toruń, Poland; (J.S.); (A.K.)
| | - Andrzej Kołtan
- Department of Pediatrics, Hematology and Oncology, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, 87-100 Toruń, Poland; (J.S.); (A.K.)
| | - Krzysztof Safranow
- Biostatistics Teaching Unit, Pomeranian Medical University, 70-204 Szczecin, Poland;
| | - Tomasz Urasiński
- Department of Pediatrics, Hemato-Oncology and Gastroenterology, Pomeranian Medical University, Unii Lubelskiej 1, 71-252 Szczecin, Poland; (A.M.); (A.K.); (T.U.)
| | - Tomasz Ociepa
- Department of Pediatrics, Hemato-Oncology and Gastroenterology, Pomeranian Medical University, Unii Lubelskiej 1, 71-252 Szczecin, Poland; (A.M.); (A.K.); (T.U.)
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2
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Menig S, Dinh A, Angus J, Tucker S, Leger KJ, Rushing T, Orgel E. Lack of benefit from premedication for pegylated asparaginase during pediatric acute lymphoblastic leukemia/lymphoma therapy: A side-by-side comparison. Pediatr Blood Cancer 2024; 71:e30716. [PMID: 37856184 DOI: 10.1002/pbc.30716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 09/11/2023] [Accepted: 09/28/2023] [Indexed: 10/20/2023]
Abstract
BACKGROUND Pegylated l-asparaginase (PEG) is integral to treatment regimens for acute lymphoblastic leukemia (ALL) and lymphoma. Hypersensitivity reactions (HSRs) to PEG are common and can preclude continued administration. Data supporting recommendations for universal premedication (UPM) prior to PEG infusion to reduce incidence of HSRs are limited; UPM has become common practice. PROCEDURES Two free-standing children's hospitals independently implemented UPM prior to PEG infusions in 2016 and 2019, respectively. In a side-by-side retrospective analysis, incidence and severity of HSRs were analyzed pre- and postimplementation of UPM in youth ≥1 years old treated with frontline PEG-containing ALL regimens (2015-2018, 2016-2020). All HSRs were centrally reviewed within each institution to confirm and grade the HSR (Common Terminology Criteria for Adverse Events, v5). Planned analyses of subsets at potentially greater risk for HSRs included intensive PEG regimens (≥5 doses), adolescent and young adults (AYA), Hispanic/Latinx ethnicity, and obesity. RESULTS In 410 patients (by institution, n = 282 and n = 128), the overall incidence of Grade ≥ 3 HSRs was 20% (56 out of 282) and 18% (23 out of 128), respectively. No difference in incidence of Grade ≥ 3 HSRs in patients with versus without UPM was found at either institution (23 vs. 19%, p = .487 and 19 vs. 17%, p = .845). UPM also did not reduce the severity of HSRs, nor influence HSR risk within any patient subset. CONCLUSIONS UPM prior to PEG infusion did not alter incidence or severity of HSRs at either institution. HSR remains a common complication of PEG therapy, impacting the patient experience. Alternative strategies to reduce HSRs are urgently required.
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Affiliation(s)
- Sarah Menig
- Department of Pharmacy, Seattle Children's Hospital, Seattle, Washington, USA
| | - Andrew Dinh
- Department of Pharmacy, Children's Hospital Los Angeles, Los Angeles, California, USA
| | - Jonathan Angus
- Department of Pharmacy, Seattle Children's Hospital, Seattle, Washington, USA
| | - Sarah Tucker
- Department of Pharmacy, Seattle Children's Hospital, Seattle, Washington, USA
| | - Kasey J Leger
- Department of Pediatrics, University of Washington, Seattle Children's Hospital, Seattle, Washington, USA
| | - Teresa Rushing
- Department of Pharmacy, Children's Hospital Los Angeles, Los Angeles, California, USA
| | - Etan Orgel
- Department of Pediatrics, University of Southern California, Los Angeles, California, USA
- Cancer and Blood Disease Institute, Children's Hospital Los Angeles, Los Angeles, California, USA
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Janardan SK, Miller TP. Adolescents and young adults (AYAs) vs pediatric patients: survival, risks, and barriers to enrollment. HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2023; 2023:581-586. [PMID: 38066874 PMCID: PMC10727024 DOI: 10.1182/hematology.2023000507] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
Adolescents and young adults (AYAs; ages 15-39 years) with acute lymphoblastic leukemia (ALL) have worse outcomes than pediatric patients with ALL. Multiple factors contribute to this differential survival. AYAs are more likely to have higher-risk leukemia biology than children with ALL. AYA patients have more choices for treatment facility and treatment protocol, as well as barriers to clinical trial enrollment, both of which can affect survival. AYAs must also navigate psychosocial factors inherent to their unique developmental stage. Furthermore, AYAs typically sustain more treatment-related toxicities than pediatric patients. Treatment on pediatric or pediatric-inspired ALL protocols at pediatric cancer centers has been associated with improved outcomes for AYAs with ALL, but there is still variation in the treatment that AYAs with ALL receive. Clinical trials focused on AYAs with ALL and individualized decision-making regarding choice of treatment facility and treatment protocol are needed to optimize the survival and long-term outcomes of this patient population.
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Affiliation(s)
- Sanyukta K Janardan
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, GA
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA
| | - Tamara P Miller
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, GA
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA
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Tan YQ, Loh CK, Makpol S. A Review of L-Asparaginase Hypersensitivity in Paediatric Acute Lymphoblastic Leukaemia Patients with Regard to the Measurement of Anti-Asparaginase Antibodies and Their Genetic Predisposition. Malays J Med Sci 2023; 30:40-51. [PMID: 37928798 PMCID: PMC10624446 DOI: 10.21315/mjms2023.30.5.4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 05/22/2022] [Indexed: 11/07/2023] Open
Abstract
L-asparaginase is effective as part of the first line childhood acute lymphoblastic leukaemia (ALL) treatment regimen but suffers the risk of antibody production causing immune-mediated sequelae. This article aimed to describe the clinical implication of L-asparaginase hypersensitivity and review the types of antibodies and genetic polymorphisms contributing to it. Clinical or subclinical L-asparaginase hypersensitivity may lead to suboptimum therapeutic effect and jeopardise the clinical outcome in ALL children. Anti-asparaginase antibodies immunoglobulin (Ig)G, IgM and IgE were identified in the L-asparaginase hypersensitivities. Enzyme-linked immunosorbent assay (ELISA) is commonly used to quantify the IgG and IgM levels. The role of IgE in mediating L-asparaginase hypersensitivity is contradictory. Moreover, the presence of antibodies may not necessarily correlate inversely with the L-asparaginase efficacies in some studies. Patients with specific genetic variants have been shown to be more susceptible to clinical hypersensitivity of L-asparaginase. With the advance of technology, gene polymorphisms have been identified among Caucasians using whole-genome or exon sequencing, but the evidence is scanty among Asians. There is lack of pre-clinical study models that could help in understanding the pathophysiological pathway co-relating the gene expression and anti-asparaginase antibody formation. In conclusion, future research studies are required to fill the current gap in understanding the immune mediated reactions towards L-asparaginase upon its administration and its potential impact to the disease outcome.
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Affiliation(s)
- Yan Qi Tan
- Department of Paediatrics, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - C-Khai Loh
- Department of Paediatrics, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - Suzana Makpol
- Department of Biochemistry, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
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Roth ME, Grimes AC, Reed DR, Weiss AR, Mittal N, Parsons SK, Freyer DR. Children's Oncology Group 2023 blueprint for research: Adolescent and young adult oncology. Pediatr Blood Cancer 2023; 70 Suppl 6:e30564. [PMID: 37439574 PMCID: PMC10630986 DOI: 10.1002/pbc.30564] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 07/03/2023] [Indexed: 07/14/2023]
Abstract
Over the past few decades, 5-year cancer survival has steadily improved for all adolescents and young adults (AYA, 15-39 years at diagnosis) combined. While encouraging, this progress simultaneously highlights a compelling need for improving survival in higher risk AYA subsets and for addressing health outcomes and health-related quality of life (HRQoL) among long-term survivors. The Children's Oncology Group (COG), in collaboration with the National Cancer Institute (NCI) and the adult network groups within the NCI National Clinical Trials Network (NCTN), has developed a large and growing portfolio of therapeutic AYA cancer clinical trials to identify optimal treatment approaches for common AYA cancers. Additional initiatives, led by the COG AYA Oncology Discipline Committee for increasing collaboration between the COG and the adult network groups, optimizing AYA clinical trial enrollment, and standardizing the assessment of HRQoL, have been highly successful to date. Further, NCTN-wide collaborations are currently underway focused on improving survival for AYA malignancies with poor prognosis and, through development of supportive care and care delivery trials, reducing the short- and long-term toxicity caused by cancer treatment. Leveraging the research infrastructure within the NCTN and the NCI Community Oncology Research Program, the COG will continue to champion meaningful advancements in health and survival for AYAs with cancer.
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Affiliation(s)
- Michael E Roth
- Division of Pediatrics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Allison C Grimes
- Department of Pediatrics, UT Health Science Center San Antonio, San Antonio, Texas, USA
| | - Damon R Reed
- Department of Individualized Cancer Management, Moffitt Cancer Center, Tampa, Florida, USA
| | - Aaron R Weiss
- Department of Pediatrics, Maine Medical Center, Portland, Maine, USA
| | - Nupur Mittal
- Department of Pediatrics, Rush Medical College, Chicago, Illinois, USA
| | - Susan K Parsons
- Institute for Clinical Research and Health Policy Studies and the Division of Hematology/Oncology, Tufts Medical Center, Tufts University School of Medicine, Boston, Massachusetts, USA
| | - David R Freyer
- Departments of Pediatrics, Medicine, and Population & Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
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Rincón Reyes DF, Padilla Agudelo JL, Pinilla da Silva AI, Ortega Quintero DM, Valencia Libreros DL, Contreras Acosta AD, Gutiérrez Triana JA. An acute lymphoblastic leukemia cell-based preclinical assay revealed functional differences between commercial brands of L-asparaginase administered in Colombia. Pediatr Blood Cancer 2023; 70:e30199. [PMID: 36633223 DOI: 10.1002/pbc.30199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 11/29/2022] [Accepted: 12/19/2022] [Indexed: 01/13/2023]
Abstract
BACKGROUND L-asparaginase (L-ASNase) is an essential component of chemotherapy strategies due to its differential action between normal and leukemic cells. Recently, concerns about the efficiency of commercial formulations administered in developing countries have been reported, and available methods have limitations for directly determining the quality of the formulation of the medications. PROCEDURE We developed a cell-based protocol to analyze the activity of different L-ASNase formulations used in Colombia to induce apoptosis of the NALM-6 cell line after 24, 48, and 72 hours, using flow cytometry. Then we compared results and determined the statistically significant differences. RESULTS Three statistically different groups, ranging from full to no activity against leukemic cells, using 0.05, 0.5, and 5.0 IU/ml concentrations, were identified. Group 1 (asparaginase codified [ASA]2-4) exhibited very low to no activity against B-cell acute lymphoblastic leukemia (B-ALL) cells. Group 2 (ASA6) exhibited intermediate-level activity, and group 3 (ASA1 and ASA5) exhibited high activity. CONCLUSIONS Differences found between the therapeutic formulations of L-ASNase distributed in Colombia raise concerns about the quality of the treatment administered to patients in low- and middle-income countries. Therefore, we recommend a preclinical evaluation of formulations of L-ASNase in order to prevent therapeutical impacts on the outcome of ALL patients.
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Affiliation(s)
- Diego Fernando Rincón Reyes
- Immunology and Molecular Epidemiology Research Group (GIEM), Escuela de Microbiología, Facultad de Salud, Universidad Industrial de Santander, Bucaramanga, Colombia
| | - José Luis Padilla Agudelo
- Immunology and Molecular Epidemiology Research Group (GIEM), Escuela de Microbiología, Facultad de Salud, Universidad Industrial de Santander, Bucaramanga, Colombia
| | - Andrea Isabel Pinilla da Silva
- Immunology and Molecular Epidemiology Research Group (GIEM), Escuela de Microbiología, Facultad de Salud, Universidad Industrial de Santander, Bucaramanga, Colombia
| | - Diana Marcela Ortega Quintero
- Immunology and Molecular Epidemiology Research Group (GIEM), Escuela de Microbiología, Facultad de Salud, Universidad Industrial de Santander, Bucaramanga, Colombia.,Clinical Laboratory, Universidad Industrial de Santander, Bucaramanga, Colombia
| | | | | | - José Arturo Gutiérrez Triana
- Immunology and Molecular Epidemiology Research Group (GIEM), Escuela de Microbiología, Facultad de Salud, Universidad Industrial de Santander, Bucaramanga, Colombia
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Alqahtani A, Alhousari D, Ali A, Yaghmour G, Orgel E, Curran E, Stock W, Bhojwani D, Alachkar H. Asparaginase toxicity in Hispanic adult and pediatric patients with acute lymphoblastic leukemia: current understanding. Expert Opin Drug Metab Toxicol 2023; 19:357-366. [PMID: 37410014 DOI: 10.1080/17425255.2023.2233412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 07/03/2023] [Indexed: 07/07/2023]
Abstract
INTRODUCTION Asparaginase is essential to chemotherapy regimens for acute lymphoblastic leukemia (ALL). Survival of patients with ALL has improved since incorporating asparaginase into chemotherapy backbones. Hispanic patients have a higher incidence of ALL than other ethnicities and suffer inferior outcomes. The inferior outcome of Hispanics is due to several factors, including the increased incidence of high-risk genetic subtypes and susceptibility to treatment-related toxicity. AREAS COVERED We summarize the current knowledge of asparaginase-related toxicity by comparing their incidence between Hispanic and non-Hispanic patients. These toxicities include hypersensitivity, hepatotoxicity, pancreatitis, thrombosis, and hypertriglyceridemia. The PubMed database and Google Scholar were used to search for this review from October 2022 to June 2023. EXPERT OPINION Except for hepatotoxicity and hypertriglyceridemia secondary to asparaginase-based treatments, which may develop more frequently among Hispanic patients with ALL, other toxicities were comparable between Hispanic and non-Hispanic patients. Nevertheless, studies with larger cohorts and more accurate capturing of Hispanic ethnicity should be conducted to fill the gaps in the current knowledge.
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Affiliation(s)
- Amani Alqahtani
- School of Pharmacy, University of Southern California, Los Angeles, CA, USA
- Department of Clinical Pharmacy, School of Pharmacy, Najran University, Najran, Saudi Arabia
| | - Diala Alhousari
- School of Pharmacy, University of Southern California, Los Angeles, CA, USA
| | - Amir Ali
- USC Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, USA
| | - George Yaghmour
- USC Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, USA
| | - Etan Orgel
- USC Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, USA
- Cancer and Blood Disease Institute, Children's Hospital of Los Angeles, Los Angeles, CA, USA
| | - Emily Curran
- The Department of Medicine, Section of Hematology & Oncology at the University of Cincinnati College of Medicine
| | - Wendy Stock
- Section of Hematology/Oncology, Department of Medicine, University of Chicago, Chicago, IL, USA
| | - Deepa Bhojwani
- USC Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, USA
- Cancer and Blood Disease Institute, Children's Hospital of Los Angeles, Los Angeles, CA, USA
| | - Houda Alachkar
- School of Pharmacy, University of Southern California, Los Angeles, CA, USA
- USC Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, USA
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8
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Poirée M, Neumann F, Thomas C, Simon P, Lunven AFR, Plantaz D, Doulet ST, Strullu M. [Prevention and management of pegaspargase associated-toxicities (excluding coagulation abnormalities). Recommendations of the French Society of Children and Adolescent Cancers (Leukemia committee)]. Bull Cancer 2022; 109:1125-1131. [PMID: 35987855 DOI: 10.1016/j.bulcan.2022.06.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 06/07/2022] [Accepted: 06/12/2022] [Indexed: 02/05/2023]
Abstract
Pegaspargase (Oncaspar®), a pegylated form of native Escherichia Coli-derived L-asparaginase is an essential component chemotherapy used in the treatment of acute lymphoblastic leukemia (ALL) in pediatric and adult patients. Its particular toxicity profile requires a specific management to improve safety and tolerability and optimize treatment outcome and therefore survival. Within the framework of workshops of practice harmonization of the French Society of Children and Adolescent Cancers, diagnostic and management of the most commonly occuring toxicities (excluding coagulation abnormalities) during Pegaspargase treatment were reviewed according to the analysis of published studies.
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Affiliation(s)
- Marilyne Poirée
- CHU, service d'oncologie et hématologie pédiatrique, Nice, France.
| | - Florent Neumann
- CHU, service d'immuno hémato oncologie pédiatrique, Dijon, France
| | - Caroline Thomas
- CHU, service d'oncologie et d'immunologie pédiatrique, Nantes, France
| | - Pauline Simon
- CHRU, service d'hémato oncologie pédiatrique, Besançon, France
| | - Anne France Ray Lunven
- AP-HP, hôpital universitaire Robert-Debré, service d'hémato-immunologie pédiatrique, Paris, France
| | - Dominique Plantaz
- CHU, hôpital Couple enfant, clinique universitaire de pédiatrie, Grenoble, France
| | | | - Marion Strullu
- AP-HP, hôpital universitaire Robert-Debré, service d'hémato-immunologie pédiatrique, Paris, France
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9
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Does L-asparaginase dose intensity correlate with acute pancreatitis in acute lymphoblastic leukemia patients? Pediatr Res 2022; 92:341-342. [PMID: 35681086 DOI: 10.1038/s41390-022-02146-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 03/01/2022] [Accepted: 05/26/2022] [Indexed: 11/08/2022]
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10
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Juluri KR, Siu C, Cassaday RD. Asparaginase in the Treatment of Acute Lymphoblastic Leukemia in Adults: Current Evidence and Place in Therapy. Blood Lymphat Cancer 2022; 12:55-79. [PMID: 35669980 PMCID: PMC9166408 DOI: 10.2147/blctt.s342052] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 05/16/2022] [Indexed: 01/19/2023] Open
Abstract
Acute lymphoblastic leukemia (ALL) is a rare hematologic malignancy resulting in the production of abnormal lymphoid precursor cells. Occurring in B-cell and T-cell subtypes, ALL is more common in children, comprising nearly 30% of pediatric malignancies, but also constitutes 1% of adult cancer diagnoses. Outcomes are age-dependent, with five-year overall survival of greater than 90% in children and less than 20% in older adults. L-asparaginase, an enzyme not found in humans, depletes serum levels of L-asparagine. As leukemic cells are unable to synthesize this amino acid, its deprivation results in cell death. The success of asparaginase-containing regimens in the treatment of pediatric ALL, and poor outcomes with conventional cytotoxic regimens in adults, have led to trials of pediatric or pediatric-inspired regimens incorporating asparaginase in the adolescent and young adult (AYA) and adult populations. Initially purified from Escherichia coli, newer formulations of asparaginase have been developed to address short half-life, high immunogenic potential, and manufacturing difficulties. Unfamiliarity with asparaginase use and management of its unique toxicities may result in treatment-decisions that negatively impact outcomes. In this review, we address the current use of asparaginase in the treatment of ALL, with an emphasis on its role in the treatment of adults, key clinical trials, recognition and management of toxicities, and ongoing directions of study.
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Affiliation(s)
- Krishna R Juluri
- Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
- Seattle Cancer Care Alliance, Seattle, WA, USA
| | - Chloe Siu
- Seattle Cancer Care Alliance, Seattle, WA, USA
- Department of Pharmacy, University of Washington School of Pharmacy, Seattle, WA, USA
| | - Ryan D Cassaday
- Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
- Seattle Cancer Care Alliance, Seattle, WA, USA
- Correspondence: Ryan D Cassaday, Email
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Is hypoalbuminemia a risk factor for high-dose methotrexate toxicity in children with acute lymphoblastic leukemia? J Egypt Natl Canc Inst 2022; 34:17. [DOI: 10.1186/s43046-022-00122-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 03/17/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Repeated high-dose methotrexate (HDMTX) is a critical component of contemporary childhood acute lymphoblastic leukemia (ALL) treatment regimens. Serum albumin is considered a carrier of methotrexate (MTX) in the blood. Hypoalbuminemia is not a rare finding in children with leukemia. This study aimed to investigate the relationship between pre-infusion serum albumin and possible HDMTX toxicities.
Methods
Thirty Egyptian children with ALL were consecutively enrolled in the study between May 2018 and July 2020. They were prospectively followed up while receiving HDMTX during the consolidation phase of the TOTAL study XV protocol. HDMTX was administered intravenously as a 24-h infusion every 2 weeks. Doses of 2.5 g/m2 were used for low-risk patients and 5 g/m2 for standard/high-risk patients. The Common Terminology Criteria for Adverse Events (V.4.03) was used to report the observed toxicities after HDMTX cycles. Plasma MTX levels were estimated at 24 h (MTX24) from the beginning of HDMTX infusion in the first consolidation cycle. Serum albumin level was determined before HDMTX administration, and pre-infusion hypoalbuminemia was defined when serum albumin was <3.5 g/dL.
Results
The patients’ age ranged from 2.3 to 13.3 years at diagnosis, and most of them had B cell ALL (86.7%). Overall, 120 HDMTX cycles were analyzed, equally distributed between low and standard/high risk. Grade 3–4 anemia, grades 3–4 thrombocytopenia, febrile neutropenia, and oral mucositis were significantly more frequent in HDMTX cycles with pre-infusion hypoalbuminemia than those with normal pre-infusion albumin (p=0.003, p=0.007, p=0.006, and p=0.001, respectively). In addition, pre-infusion hypoalbuminemia was significantly associated with additional hospitalization due to HDMTX toxicity (p=0.031). Most HDMTX toxicities were comparable irrespective of the MTX dose. Oral mucositis was more frequently encountered in the 2.5 g/m2 than the 5 g/m2 HDMTX cycles (46.7 vs. 26.7%, p=0.023). A significantly longer hospitalization (due to HDMTX toxicity) was observed in the 5 g/m2 HDMTX cycles (median= 7 days vs. 4 days, p=0.012).
Conclusions
Serum albumin levels should be checked before starting HDMTX cycles, especially in resource-limited settings where malnutrition is common, and serum MTX monitoring may not be available. Optimizing serum albumin levels before HDMTX may help decrease the possibility of HDMTX toxicities.
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Sibai H, Atenafu EG, Seki JT. Prophylaxis with low-molecular-weight heparin reduces thrombotic events and allows continuation of asparaginase containing regimens during intensification phase. Br J Haematol 2022; 197:e32-e34. [PMID: 34994976 DOI: 10.1111/bjh.18015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 12/07/2021] [Accepted: 12/08/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Hassan Sibai
- Department of Medical Oncology Hematology, Princess Margaret Cancer Centre, UHN.,Faculty of Pharmacy, Princess Margaret Cancer Centre, UHN, University of Toronto
| | | | - Jack T Seki
- Department of Medical Oncology Hematology, Princess Margaret Cancer Centre, UHN.,Faculty of Pharmacy, Princess Margaret Cancer Centre, UHN, University of Toronto
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