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Ekici A, Ayan B, Kazancı EG, Kuşku ZB, Orcan CG, Havalı C, Dorum S, Metin T, Orhaner BB. Central nervous system complications during treatment in childhood acute leukemia. Acta Neurol Belg 2024:10.1007/s13760-024-02602-0. [PMID: 39192159 DOI: 10.1007/s13760-024-02602-0] [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: 03/05/2024] [Accepted: 07/11/2024] [Indexed: 08/29/2024]
Abstract
OBJECTIVE Central nervous system (CNS) complications can be seen in patients with leukemia, depending on the disease itself and the chemotherapeutic agents used. This study focused on CNS complications during treatment in children with acute leukemia in a single pediatric institution. METHODS CNS complications were evaluated retrospectively in 115 patients with ALL and AML. Patients with CNS leukemia infiltration at the time of diagnosis or during a neurological event, late-onset encephalopathy, peripheral neuropathy, or a previous history of neurological abnormalities were excluded from the study. RESULTS A total of 115 children's clinical records with acute leukemia over a four-year period were reviewed. Acute CNS complications developed in 23.1% of acute myeloid leukemia (AML) patients and in 13.5% of acute lymphoblastic leukemia (ALL) patients. CNS complications developed most frequently during the induction phase of the treatment (66.7%). Seizures were the most common symptom (9 patients, 50%), followed by hemiparesis (4 patients, 22.2%) and headache (4 patients, 22.2%). Six patients (33.3%) had chemotherapy-induced toxic leukoencephalopathy, two (11.1%) had Wernicke's encephalopathy, and one patient (5.6%) each had sinus vein thrombosis, posterior reversible encephalopathy syndrome, and CNS infection. Sequelae occurred in three patients (16.7%), and only one patient (5.6%) died due to a CNS complication. CONCLUSION A wide variety of symptoms can be observed in childhood leukemia, depending on the disease itself, the chemotherapeutic agents used and a lot of other conditions such as nutritional problems. Our research shows that several CNS complications might manifest with similar symptoms; differentiated diagnosis between the underlying etiological reasons can be made by neuroimaging.
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Affiliation(s)
- Arzu Ekici
- Department of Pediatrics, Division of Neurology, Bursa Yuksek Ihtisas Training and Research Hospital, Mimar Sinan Avenue, Yıldırım, Bursa, Turkey.
| | - Bilgen Ayan
- Department of Pediatrics, Division of Hematology, Bursa Yuksek Ihtisas Training and Research Hospital, Bursa, Turkey
| | - Elif Güler Kazancı
- Department of Pediatrics, Division of Hematology, Bursa Yuksek Ihtisas Training and Research Hospital, Bursa, Turkey
| | - Zeynep Beyza Kuşku
- Department of Pediatrics, Bursa Yuksek Ihtisas Training and Research Hospital, Bursa, Turkey
| | - Cengiz Gökhan Orcan
- Department of Radiology, Bursa Yuksek Ihtisas Training and Research Hospital, Bursa, Turkey
| | - Cengiz Havalı
- Department of Pediatrics, Division of Neurology, Bursa Yuksek Ihtisas Training and Research Hospital, Mimar Sinan Avenue, Yıldırım, Bursa, Turkey
| | - Sevil Dorum
- Department of Pediatrics, Division of Metabolism, Bursa Yuksek Ihtisas Training and Research Hospital, Bursa, Turkey
| | - Taha Metin
- Department of Pediatrics, Bursa Yuksek Ihtisas Training and Research Hospital, Bursa, Turkey
| | - Betül Biner Orhaner
- Department of Pediatrics, Division of Hematology, Bursa Yuksek Ihtisas Training and Research Hospital, Bursa, Turkey
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Van Trimpont M, Schalk AM, De Visser Y, Nguyen HA, Reunes L, Vandemeulebroecke K, Peeters E, Su Y, Lee H, Lorenzi PL, Chan WK, Mondelaers V, De Moerloose B, Lammens T, Goossens S, Van Vlierberghe P, Lavie A. In vivo stabilization of a less toxic asparaginase variant leads to a durable antitumor response in acute leukemia. Haematologica 2022; 108:409-419. [PMID: 35979719 PMCID: PMC9890011 DOI: 10.3324/haematol.2022.281390] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2002] [Indexed: 02/03/2023] Open
Abstract
Asparagine is a non-essential amino acid since it can either be taken up via the diet or synthesized by asparagine synthetase. Acute lymphoblastic leukemia (ALL) cells do not express asparagine synthetase or express it only minimally, which makes them completely dependent on extracellular asparagine for their growth and survival. This dependency makes ALL cells vulnerable to treatment with L-asparaginase, an enzyme that hydrolyzes asparagine. To date, all clinically approved L-asparaginases have significant L-glutaminase co-activity, associated with non-immune related toxic side effects observed during therapy. Therefore, reduction of L-glutaminase co-activity with concomitant maintenance of its anticancer L-asparaginase effect may effectively improve the tolerability of this unique drug. Previously, we designed a new alternative variant of Erwinia chrysanthemi (ErA; Erwinaze) with decreased L-glutaminase co-activity, while maintaining its L-asparaginase activity, by the introduction of three key mutations around the active site (ErA-TM). However, Erwinaze and our ErA-TM variant have very short half-lives in vivo. Here, we show that the fusion of ErA-TM with an albumin binding domain (ABD)-tag significantly increases its in vivo persistence. In addition, we evaluated the in vivo therapeutic efficacy of ABD-ErA-TM in a B-ALL xenograft model of SUP-B15. Our results show a comparable long-lasting durable antileukemic effect between the standard-of-care pegylated-asparaginase and ABD-ErA-TM L-asparaginase, but with fewer co-glutaminase-related acute side effects. Since the toxic side effects of current L-asparaginases often result in treatment discontinuation in ALL patients, this novel ErA-TM variant with ultra-low L-glutaminase co-activity and long in vivo persistence may have great clinical potential.
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Affiliation(s)
- Maaike Van Trimpont
- Cancer Research Institute Ghent (CRIG), Ghent, Belgium,Department of Biomolecular Medicine, Ghent University, Ghent, Belgium,Department of Diagnostic Sciences, Ghent University, Ghent, Belgium
| | - Amanda M. Schalk
- Department of Biochemistry and Molecular Genetics, University of Illinois at Chicago, Chicago, IL, USA
| | - Yanti De Visser
- Cancer Research Institute Ghent (CRIG), Ghent, Belgium,Department of Biomolecular Medicine, Ghent University, Ghent, Belgium,Department of Imaging and Pathology, KU Leuven, Leuven, Belgium
| | - Hien Anh Nguyen
- Department of Biochemistry and Molecular Genetics, University of Illinois at Chicago, Chicago, IL, USA
| | - Lindy Reunes
- Cancer Research Institute Ghent (CRIG), Ghent, Belgium,Department of Biomolecular Medicine, Ghent University, Ghent, Belgium
| | - Katrien Vandemeulebroecke
- Cancer Research Institute Ghent (CRIG), Ghent, Belgium,Department of Pediatric Hemato-Oncology and Stem Cell Transplantation, Ghent University Hospital, Ghent, Belgium,Department of Internal Medicine and Pediatrics, Ghent University, Ghent, Belgium
| | - Evelien Peeters
- Cancer Research Institute Ghent (CRIG), Ghent, Belgium,Department of Diagnostic Sciences, Ghent University, Ghent, Belgium
| | - Ying Su
- Department of Biochemistry and Molecular Genetics, University of Illinois at Chicago, Chicago, IL, USA
| | - Hyun Lee
- Department of Pharmaceutical Sciences, College of Pharmacy, University of Illinois at Chicago (UIC), Chicago, IL, USA,Biophysics Core at Research Resources Center, University of Illinois at Chicago (UIC), Chicago, IL, USA
| | - Philip L. Lorenzi
- Metabolomics Core Facility, Department of Bioinformatics and Computational Biology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Wai-Kin Chan
- Metabolomics Core Facility, Department of Bioinformatics and Computational Biology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Veerle Mondelaers
- Cancer Research Institute Ghent (CRIG), Ghent, Belgium,Department of Pediatric Hemato-Oncology and Stem Cell Transplantation, Ghent University Hospital, Ghent, Belgium
| | - Barbara De Moerloose
- Cancer Research Institute Ghent (CRIG), Ghent, Belgium,Department of Pediatric Hemato-Oncology and Stem Cell Transplantation, Ghent University Hospital, Ghent, Belgium,Department of Internal Medicine and Pediatrics, Ghent University, Ghent, Belgium
| | - Tim Lammens
- Cancer Research Institute Ghent (CRIG), Ghent, Belgium,Department of Pediatric Hemato-Oncology and Stem Cell Transplantation, Ghent University Hospital, Ghent, Belgium,Department of Internal Medicine and Pediatrics, Ghent University, Ghent, Belgium
| | - Steven Goossens
- Cancer Research Institute Ghent (CRIG), Ghent, Belgium,Department of Diagnostic Sciences, Ghent University, Ghent, Belgium
| | - Pieter Van Vlierberghe
- Cancer Research Institute Ghent (CRIG), Ghent, Belgium,Department of Biomolecular Medicine, Ghent University, Ghent, Belgium,#PVV and AL contributed equally as co-senior authors
| | - Arnon Lavie
- Department of Biochemistry and Molecular Genetics, University of Illinois at Chicago, Chicago, USA; The Jesse Brown VA Medical Center, Chicago, IL.
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Strickler N, Balabanov S, Casauro K, Schanz U, Manz MG, Gerber B. Acute central nervous system complications and ammonium levels in adult patients with acute lymphoblastic leukemia receiving l-asparaginase. Leuk Lymphoma 2017; 59:855-862. [PMID: 28728499 DOI: 10.1080/10428194.2017.1352090] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
We analyzed ammonium levels and acute central nervous complications in adult patients receiving chemotherapy for acute lymphoblastic leukemia with or without asparaginase (l-asp). Twenty patients with a median age of 40.3 years were included. Ammonium-levels were measured during 88 chemotherapy cycles, 60 cycles (68%) with l-asp, and 28 cycles (32%) without l-asp. Ammonium was elevated in 87% of all l-asp containing cycles, with median ammonium levels of 169 μmol/l (interquartile range (IQR) 91-269 μmol/l). These values were higher when compared to ammonium levels at baseline (31.5 μmol/l, IQR 24-40 μmol/l, p < .001), and when compared to levels in cycles without l-asp (30 μmol/l, IQR 19-41 μmol/l, p < .001). Acute hyperammonemic encephalopathy was diagnosed in one patient, and encephalopathy for other reasons, but with hyperammonemia as a possible contributing factor in four patients. In conclusion, ammonium levels are elevated in all adult patients receiving l-asparaginase, but only some patients will present symptoms of encephalopathy.
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Affiliation(s)
- Nicole Strickler
- a Department of Hematology and Oncology, Division of Hematology , University and University Hospital Zurich , Zurich , Switzerland
| | - Stefan Balabanov
- a Department of Hematology and Oncology, Division of Hematology , University and University Hospital Zurich , Zurich , Switzerland
| | - Katharina Casauro
- a Department of Hematology and Oncology, Division of Hematology , University and University Hospital Zurich , Zurich , Switzerland.,b Division of Hematology , Spital Maennedorf , Männedorf , Switzerland
| | - Urs Schanz
- a Department of Hematology and Oncology, Division of Hematology , University and University Hospital Zurich , Zurich , Switzerland
| | - Markus G Manz
- a Department of Hematology and Oncology, Division of Hematology , University and University Hospital Zurich , Zurich , Switzerland
| | - Bernhard Gerber
- a Department of Hematology and Oncology, Division of Hematology , University and University Hospital Zurich , Zurich , Switzerland.,c Division of Hematology , Oncology Institute of Southern Switzerland , Bellinzona , Switzerland
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5
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Hijiya N, van der Sluis IM. Asparaginase-associated toxicity in children with acute lymphoblastic leukemia. Leuk Lymphoma 2015; 57:748-57. [PMID: 26457414 PMCID: PMC4819847 DOI: 10.3109/10428194.2015.1101098] [Citation(s) in RCA: 134] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Asparaginase is an integral component of multiagent chemotherapy regimens for the treatment of children with acute lymphoblastic leukemia. Positive outcomes are seen in patients who are able to complete their entire prescribed course of asparaginase therapy. Toxicities associated with asparaginase use include hypersensitivity (clinical and subclinical), pancreatitis, thrombosis, encephalopathy, and liver dysfunction. Depending on the nature and severity of the toxicity, asparaginase therapy may be altered or discontinued in some patients. Clinical hypersensitivity is the most common asparaginase-associated toxicity requiring treatment discontinuation, occurring in up to 30% of patients receiving Escherichia coli-derived asparaginase. The ability to rapidly identify and manage asparaginase-associated toxicity will help ensure patients receive the maximal benefit from asparaginase therapy. This review will provide an overview of the common toxicities associated with asparaginase use and recommendations for treatment management.
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Affiliation(s)
- Nobuko Hijiya
- a Division of Hematology/Oncology/Stem Cell Transplant, Ann & Robert H. Lurie Children's Hospital of Chicago and Department of Pediatrics, Feinberg School of Medicine , Northwestern University , Chicago , IL , USA
| | - Inge M van der Sluis
- b Department of Pediatric Oncology/Hematology , Erasmus MC-Sophia Children's Hospital , Rotterdam , The Netherlands
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