1. Adequate asparaginase is important to prevent central nervous system and testicular relapse of pediatric Philadelphia chromosome‐negative B‐cell acute lymphoblastic leukemia
- Author
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Jing Chen, Yanjing Tang, Ruichi Wu, Jiaoyang Cai, Changcheng Chen, Chenxi Liu, Binxiao Huang, Xiaoxiao Chen, Jing Li, Min Zhou, Shuhong Shen, and Wenting Hu
- Subjects
Male ,China ,Cancer Research ,Asparaginase ,medicine.medical_specialty ,Adolescent ,Philadelphia Chromosome Negative ,Central nervous system ,Relapse prevention ,Gastroenterology ,Central Nervous System Neoplasms ,03 medical and health sciences ,chemistry.chemical_compound ,0302 clinical medicine ,Testicular Neoplasms ,Pharmacokinetics ,Internal medicine ,Escherichia coli ,medicine ,Humans ,Philadelphia Chromosome ,Child ,Retrospective Studies ,B-Lymphocytes ,business.industry ,Incidence (epidemiology) ,Infant ,Retrospective cohort study ,Precursor Cell Lymphoblastic Leukemia-Lymphoma ,Prognosis ,medicine.anatomical_structure ,Oncology ,chemistry ,Child, Preschool ,030220 oncology & carcinogenesis ,Cohort ,Female ,Neoplasm Recurrence, Local ,business ,Follow-Up Studies - Abstract
Asparaginase (Asp) is one of the most important drugs for treating acute lymphoblastic leukemia (ALL). However, off-protocol Asp administration (OPAA) or hypersensitivity may disturb its pharmacokinetic profile. In this retrospective study, we sought to determine whether OPAA and hypersensitivity to Escherichia coli asparaginase (E coli Asp) impaired extramedullary relapse prevention in a pediatric ALL cohort treated according to SCMC-ALL-2005 protocol from 2005 to 2014 at the Shanghai Children's Medical Center (SCMC). In total, 676 patients were enrolled in this study, including 369 with OPAA and 60 exhibiting hypersensitivity to E coli Asp. At the end of the most recent follow-up, 58 patients had extramedullary relapse. The 5-year cumulative extramedullary relapse incidence in patients with OPAA was 11.01%, whereas that in patients without OPAA was 5.28% (P = .0036). Moreover, the 5-year cumulative extramedullary relapse incidence in patients that exhibited hypersensitivity to E coli Asp was 16.48%, whereas that in patients without hypersensitivity was 7.59% (P = .0195). Concerning the relapse site, OPAA not only increased central nervous system (CNS) relapse but testicular relapse as well. Based on Fine and Gray multivariate analysis, OPAA and hypersensitivity to Asp were independent risk factors for extramedullary relapse. In conclusion, to prevent extramedullary relapse of ALL, adequate duration to administrate Asp was more important than the total dosage, and more attention should be paid to Asp inadequate due to hypersensitivity.
- Published
- 2021