Can monitoring asparaginase activity help us to manage toxicity in pediatric acute lymphoblastic leukemia?

Hernández-Marqués, Carmen; Andión, Maitane; Perez‐Somarriba, Marta; Madero, Luís; Lassaletta, Álvaro

doi:10.1080/10428194.2019.1691191

Cited by 2 publications

(3 citation statements)

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“…[12][13][14] Interpatient variability, pharmacokinetic differences in asparaginase formulations and host-related factors can affect the enzymatic activity, so that to ensure optimal treatment and reduce toxicity, physicians should be aware of these sources of variability and be ready to make any necessary treatment adjustments. [15][16][17] A failure to implement asparaginase drug monitoring may fail to recognize patients who warrant a switch to Erwinia. Therefore, therapeutic drug monitoring is particularly useful for optimizing asparaginase treatment, and when a tight pharmacological monitoring program is established, premedication could be implemented more broadly to minimize the risk of adverse reactions.…”

Section: Introductionmentioning

confidence: 99%

“…Although there is no universally accepted dose or treatment schedule for all patients, it has been generally recommended that ≥100 IU/L is an appropriate target trough level of asparaginase activity 12–14 . Interpatient variability, pharmacokinetic differences in asparaginase formulations and host‐related factors can affect the enzymatic activity, so that to ensure optimal treatment and reduce toxicity, physicians should be aware of these sources of variability and be ready to make any necessary treatment adjustments 15–17 …”

Section: Introductionmentioning

confidence: 99%

“… 12 , 13 , 14 Interpatient variability, pharmacokinetic differences in asparaginase formulations and host‐related factors can affect the enzymatic activity, so that to ensure optimal treatment and reduce toxicity, physicians should be aware of these sources of variability and be ready to make any necessary treatment adjustments. 15 , 16 , 17 …”

Section: Introductionmentioning

confidence: 99%

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Asparaginase activity monitoring in pediatric acute lymphoblastic leukemia: A cross‐sectional nationwide study in Spain

Lassaletta

Gutiérrez

2022

Cancer Reports

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Background: A cross-sectional nationwide study was designed to assess national compliance with international consensus/guidelines of monitoring asparaginase levels in children with acute lymphoblastic leukemia (ALL) treated with asparaginase in routine clinical practice.Methods: An ad hoc questionnaire was designed and completed by staff physicians from Hemato-Oncology Units throughout Spain.Results: A total of 39 physicians (64% pediatricians) with a mean (SD) age 43.5 (7.9) years and 15.3 (17.6) years of professional activity participated in the study. They accounted for 90% of hospitals in which children with ALL are treated in Spain. A total of 19 participants (48.7%) reported that asparaginase levels were routinely monitored (own center in 2 cases [10.5%], another hospital in 17 cases [89.5%]). Asparaginase was not monitored in 51.3% of the cases, mostly (80%) because unavailability of testing. When asparaginase was monitored, 68% of participants reported that this was done in all asparaginase-treated patients and 84% in all phases of the disease (induction, consolidation, re-induction, maintenance) with a time interval of 7 days for the pegylated form, 48 h for Erwinia asparaginase and 14 days for maintenance with the pegylated form. All participants reported that they modified treatment according to results of testing, with a limit of total depletion of ≥100 IU/L. Levels <100 or 20 IU/L were considered indicative of hypersensitivity by 46% of physicians. Conclusion:There is still a gap between what is recommended and what is done in clinical practice, with more than 50% of centers not monitoring the level of asparaginase activity in pediatric ALL. Protocols for asparaginase testing in daily practice should be implemented.

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