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. 2022 Nov 4;11(1):86.
doi: 10.1186/s40164-022-00351-5.

Follow our path with asparaginase activity: one technique, but different uses in clinical practice

Daiane Keller Cecconello  1   2   3 , Ciliana Rechenmacher  1   2   3 , Klerize Anecely de Souza Silva  1 , Fernanda Fetter Scherer  3 , Thomas Dal Bem Prates  3 , Rebeca Ferreira Marques  3 , Liane Esteves Daudt  1   2   3 , Mariana Bohns Michalowski  4   5   6
Affiliations

Follow our path with asparaginase activity: one technique, but different uses in clinical practice

Daiane Keller Cecconello et al. Exp Hematol Oncol. .

Abstract

Acute lymphoblastic leukemia is the most common childhood malignancy. One of the drugs used in the treatment is Asparaginase, and monitoring of its activity levels enables better outcomes. Since 2018, our laboratory has been working to establish a regular analysis of activity. This implementation allowed to qualify care by detecting silent inactivation and also establishing desensitization as a safe way to overcome the lack of Erwinia. We were able to monitor children aged 0 to 18 years who were being treated with PEG-ASNase. The activity was assessed on days 7 (90 samples) and 14 (52 samples) after ASNase infusions. 142 samples were analyzed. 95.7% reached an adequate activity level (≥ 0.1 IU/mL). Patients treated with ASNase can develop allergic reactions. With the activity monitoring, is possible to circumvent situations like these and implement desensitization protocols for patients who had clinical hypersensitivity without inactivation. Desensitization induces temporary unresponsiveness to drug antigens, allowing the patients to proceed with the prescribed chemotherapy. We have received samples from four patients being treated with different desensitization protocols. Patients tolerated the protocols well. Only one had a grade 2 reaction during the infusion and activity < 0.1 IU/mL, which resulted in the switch to Erwinia. The dose adaptation is a possible and more recent use of ASNase monitoring and we were able to confirm the feasibility of PEG-ASNase desensitization protocols.

Keywords: Acute lymphoblastic leukemia; Desensitization protocols; Enzimatic activity; PEG asparaginase.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Enzymatic activity (IU/mL) distribution assessed 7 and 14 days after infusion (n = 142 samples). Medians (IQR) were 0.654 (0.420–1.017) and 0.512 (0.321–0.796) on days 7 and 14, respectively. Values were distributed according to the % of samples and the number of infusions on days 7 and 14. IQR: Interquartile range
See this image and copyright information in PMC

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