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Review
. 2011 Jan 15;117(2):238-49.
doi: 10.1002/cncr.25489. Epub 2010 Sep 7.

L-asparaginase treatment in acute lymphoblastic leukemia: a focus on Erwinia asparaginase

Rob Pieters  1 , Stephen P Hunger, Joachim Boos, Carmelo Rizzari, Lewis Silverman, Andre Baruchel, Nicola Goekbuget, Martin Schrappe, Ching-Hon Pui
Affiliations
Review

L-asparaginase treatment in acute lymphoblastic leukemia: a focus on Erwinia asparaginase

Rob Pieters et al. Cancer. .

Abstract

Asparaginases are a cornerstone of treatment protocols for acute lymphoblastic leukemia (ALL) and are used for remission induction and intensification treatment in all pediatric regimens and in the majority of adult treatment protocols. Extensive clinical data have shown that intensive asparaginase treatment improves clinical outcomes in childhood ALL. Three asparaginase preparations are available: the native asparaginase derived from Escherichia coli (E. coli asparaginase), a pegylated form of this enzyme (PEG-asparaginase), and a product isolated from Erwinia chrysanthemi, ie, Erwinia asparaginase. Clinical hypersensitivity reactions and silent inactivation due to antibodies against E. coli asparaginase, lead to inactivation of E. coli asparaginase in up to 60% of cases. Current treatment protocols include E. coli asparaginase or PEG-asparaginase for first-line treatment of ALL. Typically, patients exhibiting sensitivity to one formulation of asparaginase are switched to another to ensure they receive the most efficacious treatment regimen possible. Erwinia asparaginase is used as a second- or third-line treatment in European and US protocols. Despite the universal inclusion of asparaginase in such treatment protocols, debate on the optimal formulation and dosage of these agents continues. This article provides an overview of available evidence for optimal use of Erwinia asparaginase in the treatment of ALL.

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Conflict of interest statement

Conflict of interest:

Pieters R is involved in scientific collaborations with different companies producing and developing asparaginases.

Hunger S is the Ergen Family Chair in Pediatric Cancer.

Boos J: Served personally as consultant and participated in advisory boards for different asparaginase-selling companies, including EUSA Pharma and former license holders. In addition, J Boos is also involved in scientific collaborations with different companies producing and developing asparaginase

Rizzari C. is involved in scientific researches supported by different companies producing and/or marketing asparaginase products.

Silverman L served on advisory board for EUSA Pharma and as a consultant for Enzon Pharmaceuticals.

Baruchel A had received honorarium for lecture from OPI

Gökbuget N is involved in scientific collaborations with different companies producing and developing asparaginases

Schrappe M is involved in scientific collaborations with different companies producing and developing asparaginases.

Pui CH had received honorarium for lecture from EUSA Pharma.

Figures

Figure 1
Figure 1
Effect of intensification with asparaginases on event-free survival

  1. Silverman et al. (2)

  2. Amylon et al. (38)

  3. Amylon et al. (38)

  4. Rizzari et al. (42)

  5. Pession et al. (41)

  6. Moghrabi et al. (40)

  7. Duval et al. (39)

EFS, event-free survival Intensification studies 1 Less than or greater than 25 weeks of treatment 2–5 Additional 20 weeks of treatment 6–7 Erwina vs E.Coli-ASP *p<0.05; **p<0.01; ***p<0.001
See this image and copyright information in PMC

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