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Emadi A, Law JY, Strovel ET, Lapidus RG, Jeng LJB, Lee M, Blitzer MG, Carter-Cooper BA, Sewell D, Van Der Merwe I, Philip S, Imran M, Yu SL, Li H, Amrein PC, Duong VH, Sausville EA, Baer MR, Fathi AT, Singh Z, Bentzen SM. Asparaginase Erwinia chrysanthemi effectively depletes plasma glutamine in adult patients with relapsed/refractory acute myeloid leukemia. Cancer Chemother Pharmacol 2017; 81:217-222. [PMID: 29119293 DOI: 10.1007/s00280-017-3459-6] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 10/13/2017] [Indexed: 12/30/2022]
Abstract
Depletion of glutamine (Gln) has emerged as a potential therapeutic approach in the treatment of acute myeloid leukemia (AML), as neoplastic cells require Gln for synthesis of cellular components essential for survival. Asparaginases deplete Gln, and asparaginase derived from Erwinia chrysanthemi (Erwinaze) appears to have the greatest glutaminase activity of the available asparaginases. In this Phase I study, we sought to determine the dose of Erwinaze that safely and effectively depletes plasma Gln levels to ≤ 120 μmol/L in patients with relapsed or refractory (R/R) AML. Five patients were enrolled before the study was halted due to issues with Erwinaze manufacturing supply. All patients received Erwinaze at a dose of 25,000 IU/m2 intravenously three times weekly for 2 weeks. Median trough plasma Gln level at 48 h after initial Erwinaze administration was 27.6 μmol/L, and 80% (lower limit of 1-sided 95% CI 34%) of patients achieved at least one undetectable plasma Gln value (< 12.5 μmol/L), with the fold reduction (FR) in Gln level at 3 days, relative to baseline, being 0.16 (p < 0.001 for rejecting FR = 1). No dose-limiting toxicities were identified. Two patients responded, one achieved partial remission and one achieved hematologic improvement after six doses of Erwinaze monotherapy. These data suggest asparaginase-induced Gln depletion may have an important role in the management of patients with AML, and support more pharmacologic and clinical studies on the mechanistically designed asparaginase combinations in AML.
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Affiliation(s)
- Ashkan Emadi
- University of Maryland Greenebaum Comprehensive Cancer Center, Baltimore, USA. .,Department of Medicine, University of Maryland, Baltimore, USA. .,Department of Pharmacology, University of Maryland, Baltimore, USA.
| | - Jennie Y Law
- University of Maryland Greenebaum Comprehensive Cancer Center, Baltimore, USA.,Department of Medicine, University of Maryland, Baltimore, USA
| | - Erin T Strovel
- Department of Pediatrics, University of Maryland, Baltimore, USA
| | - Rena G Lapidus
- University of Maryland Greenebaum Comprehensive Cancer Center, Baltimore, USA.,Department of Medicine, University of Maryland, Baltimore, USA
| | - Linda J B Jeng
- Department of Medicine, University of Maryland, Baltimore, USA.,Department of Pediatrics, University of Maryland, Baltimore, USA.,Department of Pathology, University of Maryland, Baltimore, USA
| | - Myounghee Lee
- University of Maryland Greenebaum Comprehensive Cancer Center, Baltimore, USA
| | - Miriam G Blitzer
- Department of Pediatrics, University of Maryland, Baltimore, USA
| | | | - Danielle Sewell
- Department of Medicine, University of Maryland, Baltimore, USA
| | | | - Sunita Philip
- University of Maryland Greenebaum Comprehensive Cancer Center, Baltimore, USA
| | - Mohammad Imran
- University of Maryland Greenebaum Comprehensive Cancer Center, Baltimore, USA
| | - Stephen L Yu
- University of Maryland Greenebaum Comprehensive Cancer Center, Baltimore, USA
| | - Hongxia Li
- University of Maryland Greenebaum Comprehensive Cancer Center, Baltimore, USA
| | - Philip C Amrein
- Massachusetts General Hospital Harvard Medical School, Boston, USA
| | - Vu H Duong
- University of Maryland Greenebaum Comprehensive Cancer Center, Baltimore, USA.,Department of Medicine, University of Maryland, Baltimore, USA
| | - Edward A Sausville
- University of Maryland Greenebaum Comprehensive Cancer Center, Baltimore, USA.,Department of Medicine, University of Maryland, Baltimore, USA.,Department of Pharmacology, University of Maryland, Baltimore, USA
| | - Maria R Baer
- University of Maryland Greenebaum Comprehensive Cancer Center, Baltimore, USA.,Department of Medicine, University of Maryland, Baltimore, USA
| | - Amir T Fathi
- Massachusetts General Hospital Harvard Medical School, Boston, USA
| | - Zeba Singh
- Department of Pathology, University of Maryland, Baltimore, USA
| | - Søren M Bentzen
- University of Maryland Greenebaum Comprehensive Cancer Center, Baltimore, USA.,Epidemiology and Public Health, University of Maryland, Baltimore, USA
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