Use of PEG-asparaginase in newly diagnosed adults with standard-risk acute lymphoblastic leukemia compared with E. coli-asparaginase: a retrospective single-center study.

Wen-Jian Liu,Meng-Yuan Zhu,Cheng-Cheng Liu,Jing-Hua Wang,Hua Wang,Wei-Da Wang,Yue Lu

doi:10.1038/srep39463

Wen-Jian Liu, Meng-Yuan Zhu + Show 5 more

Open Access

https://doi.org/10.1038/srep39463

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Abstract

Acute lymphoblastic leukemia (ALL) is a heterogeneous disease, and the long-term survival varies with different ages. We performed a retrospective analysis of 122 newly diagnosed adults with standard-risk ALL treated with Escherichia coli asparaginase (E. coli-asparaginase, n = 50) and polyethylene glycol-conjugated asparaginase (PEG-asparaginase, n = 72). No treatment-related mortality (TRM) occurred in the E. coli-asparaginase group, and 3 TRM events occurred in the PEG-asparaginase group without relation to asparaginase. In addition, 22 (44.0%) and 48 (66.7%) patients achieved a complete response (CR) on day 14 in the E. coli-asparaginase and PEG-asparaginase groups, respectively (P = 0.032). No different 5-year event-free survival (EFS) or overall survival (OS) rate (P = 0.632 and 0.769) was observed. Multivariate analysis revealed later CR (P = 0.008) and older age (P = 0.049) as adverse prognostic factors for both EFS and OS. In addition, we specifically monitored the known adverse effects of asparaginase, and no asparaginase-related death was observed. Allergy occurred in 9 patients using E. coli-asparaginase, and no patient in the PEG-asparaginase group suffered from allergies (P < 0.001). The incidence of other asparaginase-related toxicities was similar. We conclude that PEG-asparaginase can be safely and effectively used as asparaginase in adults with newly diagnosed standard-risk ALL.

Highlights

Abnormalities of lipid metabolism, contribute to the limitations[12,17,18]
Given that limited information has been reported on the comparison between E. coli-asparaginase and PEG-asparaginase in adults with newly diagnosed Acute lymphoblastic leukemia (ALL) to date, we investigated this issue in our single-center series
No significant differences were observed between the two groups with respect to age, sex, immunophenotype, Eastern Cooperative Oncology Group (ECOG) performance status, extramedullary leukemia, and cerebrospinal fluid (CSF) positivity at diagnosis

Summary

Introduction

Abnormalities of lipid metabolism, contribute to the limitations[12,17,18]. Compared with E. coli-asparaginase, PEG-asparaginase produces prolonged depletion of asparagine and is associated with reduced incidence of certain toxicities (i.e., hypersensitivity reactions), thereby making it preferable for use in ALL treatment[19,20,21]. Steady improvements in the cure rate for adults have been achieved through accurate diagnoses; the use of intensive combination chemotherapy; attention to potential sanctuary sites, such as the central nervous system (CNS); and the appropriate use of allogeneic hematopoietic stem-cell transplant (allo-HSCT). The long overall survival (OS) and event-free survival (EFS) of ALL in adults remain poor compared with children, and no clear consensus has been reached as to whether allo-HSCT is advantageous compared with the most effective available chemotherapy for consolidation of adults with standard-risk ALL while in the first complete response (CR1)[25,26,27]. Given that limited information has been reported on the comparison between E. coli-asparaginase and PEG-asparaginase in adults with newly diagnosed ALL to date, we investigated this issue in our single-center series

Methods

Results

Conclusion