How to optimize asparaginase treatment in ALL? - NOPHO experience

Aktivitet: Tale eller præsentation - typerForedrag og mundtlige bidrag

Se relationer på Aarhus Universitet

BK Albertsen - Foredragsholder

  • Børneafdeling, SKS
 

How to optimize asparaginase treatment in ALL?

Background:

Asparaginase is an old and important drug in ALL therapy, but the challenge is still to design a treatment schedule that results in the best possible EFS and in an acceptable level of side effects at the same time.

 

Purpose:

In order to optimize therapy

- Exploration of data from treatment with different asparaginase preparations in the NOPHO-protocols since 1992 in respect to dose, way of administration and side effect

 

Material:

Children aged 1-15 (-18) years treated with Erwinase®, native E.coli (Medac®) or PEG-asparaginase (Medac®) after the following NOPHO-protocols; ALL-92, ALL-2000 and ALL-2008.

Patients have been monitored with one or more of the following parameters: enzyme activities, amino acids, silent antibodies, registration of side effects.

 

Results:

Erwinase® is an excellent drug with relatively few side effects, but the major problem using this drug is the short half-life.

Native E.coli (Medac®) has a longer half-life, so that the drug can be administered with longer intervals compared to Erwinase®. Unfortunately, approximately one third of the patients developed silent antibodies in NOPHO ALL-2000.

PEG-asparaginase (Medac®) has a longer half-life and is less immunogenic. Administration of PEG-asparaginase (Medac®) every second week results in sufficient asparaginase activities during the whole period and very few patients have so far developed silent antibodies after several doses during prolonged asparaginase treatment in ALL-2008.

 

Conclusion:

The NOPHO experience with asparaginase since ALL-92 as well as international studies with prolonged asparaginase treatment are the fundamental basis for the randomized trial in the NOPHO ALL-2008 protocol, where patients are randomised to continuous or intermittent PEG-asparaginase therapy.

 

Key-words:

asparaginase preparation, half-life, dose, silent antibodies, side effects

 


Emneord: asparaginase preparation, half-life, dose, silent antibodies, side effects
7 jun. 2009

Begivenhed (Konference)

TitelNOPHO's 27. årsmøde
Dato07/06/200907/06/2009
EmneBørneonkologi
ByÅrhus
LandDanmark

ID: 19337122