Contributions
Abstract: PB1640
Type: Publication Only
Background
Overall survival in Adult Acute Lymphoblastic Leukaemia (ALL) has improved with time, the drug L-Asparaginase is an essential component in ALL treatment protocols, both in paediatrics and adults.
Aims
Compared to paediatric patients, adult patients tolerate intensive chemotherapy regimens less well. This audit investigated the use of PEG-ylated L-Asparaginase (PEG-L-ASP) in adult ALL chemotherapy regimens and its adverse effects, namely: hepatotoxicity, pancreatitis and hypertriglyceridemia.
Methods
Thirteen patients in the UKALL14 trial and nine in the UKALL2011 trial were studied by case note review retrospectively. These groups allowed age comparison: 30-55 years (UKALL14) and 17-24 years (UKALL2011). Toxicity gradings were calculated using the Common Terminology Criteria for Adverse Effects v4.0 (US Department of Health and Human Services, 2009).
Results
Overall the older patients had higher hepatotoxicity gradings than the younger patients (see Table). More critically, none of the older cohort could complete their proposed schedule because of PEG-L-ASP related toxicity compared to 78% of the younger cohort.
Conclusion
This audit demonstrated significant toxicity of PEG-L-ASP in patients aged greater than 30 years. Toxicity of PEG-L-ASP has previously been noted in Ph positive adult ALL patients undergoing therapy. Treatment delays are very undesirable in the treatment of ALL. Alternative therapy with non-PEG-ylated L-Asparaginase allows for drug withdrawal if toxicity occurs because of its shorter half life. However, PEG-L-ASP has shown to be beneficial in paediatric and adolescent ALL protocols because of its faster asparagine depletion and more prolonged effects. While the optimum form of L-Asparaginase to use in older adult patients remains under investigation, our clinical practice in light of our findings, has been to revert to conventional asparaginase (Erwinia) in adult patients over 30 years old.
Session topic: 2. Acute lymphoblastic leukemia - Clinical
Keyword(s): Acute lymphoblastic leukemia, adult, Asparaginase
Abstract: PB1640
Type: Publication Only
Background
Overall survival in Adult Acute Lymphoblastic Leukaemia (ALL) has improved with time, the drug L-Asparaginase is an essential component in ALL treatment protocols, both in paediatrics and adults.
Aims
Compared to paediatric patients, adult patients tolerate intensive chemotherapy regimens less well. This audit investigated the use of PEG-ylated L-Asparaginase (PEG-L-ASP) in adult ALL chemotherapy regimens and its adverse effects, namely: hepatotoxicity, pancreatitis and hypertriglyceridemia.
Methods
Thirteen patients in the UKALL14 trial and nine in the UKALL2011 trial were studied by case note review retrospectively. These groups allowed age comparison: 30-55 years (UKALL14) and 17-24 years (UKALL2011). Toxicity gradings were calculated using the Common Terminology Criteria for Adverse Effects v4.0 (US Department of Health and Human Services, 2009).
Results
Overall the older patients had higher hepatotoxicity gradings than the younger patients (see Table). More critically, none of the older cohort could complete their proposed schedule because of PEG-L-ASP related toxicity compared to 78% of the younger cohort.
Conclusion
This audit demonstrated significant toxicity of PEG-L-ASP in patients aged greater than 30 years. Toxicity of PEG-L-ASP has previously been noted in Ph positive adult ALL patients undergoing therapy. Treatment delays are very undesirable in the treatment of ALL. Alternative therapy with non-PEG-ylated L-Asparaginase allows for drug withdrawal if toxicity occurs because of its shorter half life. However, PEG-L-ASP has shown to be beneficial in paediatric and adolescent ALL protocols because of its faster asparagine depletion and more prolonged effects. While the optimum form of L-Asparaginase to use in older adult patients remains under investigation, our clinical practice in light of our findings, has been to revert to conventional asparaginase (Erwinia) in adult patients over 30 years old.
Session topic: 2. Acute lymphoblastic leukemia - Clinical
Keyword(s): Acute lymphoblastic leukemia, adult, Asparaginase