Childhood Acute Lymphoblastic Leukemia Treatment (PDQ®): Treatment - Health Professional Information
Childhood Acute Lymphoblastic Leukemia Treatment (PDQ®): Treatment - Health Professional Information [NCI]-Treatment for Newly Diagnosed Childhood ALL
Childhood Acute Lymphoblastic Leukemia Treatment (PDQ®): Treatment - Health Professional Information [NCI] Guide
Evidence (use of PEG-L-asparaginase instead of native E. coli L-asparaginase):
Patients with an allergic reaction to PEG-L-asparaginase should be switched to Erwinia L-asparaginase.
ErwiniaL-asparaginase:
Erwinia L-asparaginase is typically used in patients who have experienced allergy to native E. coli or PEG-L-asparaginase.
The half-life of Erwinia L-asparaginase (0.65 days) is much shorter than that of native E. coli (1.2 days) or PEG-L-asparaginase (5.7 days).[20] If Erwinia L-asparaginase is utilized, the shorter half-life of the Erwinia preparation requires more frequent administration to achieve adequate asparagine depletion.
Evidence (increased dose frequency of Erwinia L-asparaginase needed to achieve goal therapeutic effect):
Childhood Acute Lymphoblastic Leukemia Treatment (PDQ®): Treatment - Health Professional Information [NCI] - Treatment for Newly Diagnosed Childhood ALL
Childhood Acute Lymphoblastic Leukemia Treatment (PDQ®): Treatment - Health Professional Information [NCI] Guide
- General Information About Childhood Acute Lymphoblastic Leukemia (ALL)
- Risk-based Treatment Assignment
- Treatment Option Overview for Childhood ALL
- Treatment for Newly Diagnosed Childhood ALL
- Postinduction Treatment for Childhood ALL
- CNS-directed Therapy for Childhood ALL
- Postinduction Treatment for Specific ALL Subgroups
- Treatment of Relapsed Childhood ALL
- Changes to this Summary (05 / 02 / 2014)
- About This PDQ Summary
- Get More Information From NCI
Evidence (use of PEG-L-asparaginase instead of native E. coli L-asparaginase):
- A randomized comparison of PEG-L-asparaginase versus native E. coli asparaginase was conducted. Each agent was administered for a 30-week period after the achievement of CR.[22]
- Similar outcome and similar rates of asparaginase-related toxicities were observed for both groups of patients.
- Another randomized trial of patients with standard-risk ALL assigned patients to receive either PEG-L-asparaginase or native E. coli asparaginase in induction and each of two delayed intensification courses.[21]
- A single dose of PEG-L-asparaginase given in conjunction with vincristine and prednisone during induction therapy appeared to have similar activity and toxicity as nine doses of IM E. coli L-asparaginase (3 times a week for 3 weeks).[21]
- The use of PEG-L-asparaginase was associated with more rapid blast clearance and a lower incidence of neutralizing antibodies.
Patients with an allergic reaction to PEG-L-asparaginase should be switched to Erwinia L-asparaginase.
ErwiniaL-asparaginase:
Erwinia L-asparaginase is typically used in patients who have experienced allergy to native E. coli or PEG-L-asparaginase.
The half-life of Erwinia L-asparaginase (0.65 days) is much shorter than that of native E. coli (1.2 days) or PEG-L-asparaginase (5.7 days).[20] If Erwinia L-asparaginase is utilized, the shorter half-life of the Erwinia preparation requires more frequent administration to achieve adequate asparagine depletion.
Evidence (increased dose frequency of Erwinia L-asparaginase needed to achieve goal therapeutic effect):
- In two studies, newly diagnosed patients were randomly assigned to receive the same schedule and dosage of Erwinia L-asparaginase or E. coli L-asparaginase.[23,24]
- Patients who received Erwinia L-asparaginase had a significantly worse EFS.
- When administered more frequently (twice weekly), the use of Erwinia L-asparaginase did not adversely impact EFS in patients who had experienced an allergic reaction to E. coli L-asparaginase.[25]
- A COG trial demonstrated that IM Erwinia L-asparaginase given three times a week to patients with an allergy to PEG L-asparaginase leads to therapeutic serum asparaginase enzyme activity levels (defined as a level ≥0.1 IU/mL). On that trial, 96% of children achieved a level of 0.1 IU/mL or more at 2 days and 85% did so at 3 days.[26]
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