L-asparaginase treatment in acute lymphoblastic leukemia: a focus on Erwinia asparaginase.
Summary of "L-asparaginase treatment in acute lymphoblastic leukemia: a focus on Erwinia asparaginase."
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. Cancer 2010. (c) 2010 American Cancer Society.
Affiliation
Erasmus MC-Sophia Children's Hospital, Rotterdam, Netherlands.
Journal Details
This article was published in the following journal.
Name: Cancer
ISSN: 0008-543X
Pages:
Links
- PubMed Source: http://www.ncbi.nlm.nih.gov/pubmed/20824725
- DOI: http://dx.doi.org/10.1002/cncr.25489
Medical and Biotech [MESH] Definitions
Asparaginase
A hydrolase enzyme that converts L-asparagine and water to L-aspartate and NH3. EC 3.5.1.1.
Cytarabine
A pyrimidine nucleoside analog that is used mainly in the treatment of leukemia, especially acute non-lymphoblastic leukemia. Cytarabine is an antimetabolite antineoplastic agent that inhibits the synthesis of DNA. Its actions are specific for the S phase of the cell cycle. It also has antiviral and immunosuppressant properties. (From Martindale, The Extra Pharmacopoeia, 30th ed, p472)
Spleen Focus-forming Viruses
Strains of MURINE LEUKEMIA VIRUS that are replication-defective and rapidly transforming. The envelope gene plays an essential role in initiating erythroleukemia (LEUKEMIA, ERYTHROBLASTIC, ACUTE), manifested by splenic foci, SPLENOMEGALY, and POLYCYTHEMIA. Spleen focus-forming viruses are generated by recombination with endogenous retroviral sequences.
Neprilysin
Enzyme that is a major constituent of kidney brush-border membranes and is also present to a lesser degree in the brain and other tissues. It preferentially catalyzes cleavage at the amino group of hydrophobic residues of the B-chain of insulin as well as opioid peptides and other biologically active peptides. The enzyme is inhibited primarily by EDTA, phosphoramidon, and thiorphan and is reactivated by zinc. Neprilysin is identical to common acute lymphoblastic leukemia antigen (CALLA Antigen), an important marker in the diagnosis of human acute lymphocytic leukemia. There is no relationship with CALLA PLANT.
Precursor B-cell Lymphoblastic Leukemia-lymphoma
A leukemia/lymphoma found predominately in children and adolescents and characterized by a high number of lymphoblasts and solid tumor lesions. Frequent sites involve LYMPH NODES, skin, and bones. It most commonly presents as leukemia.
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