Optimizing use of L-asparaginase–based treatment of adults with acute lymphoblastic leukemia

Acute lymphoblastic leukemia (ALL) is a malignancy of lymphoid progenitor cells occurring at an annual incidence rate of approximately 1.1 to 2.1 per 100,000 person-years globally. Approximately 40% of annual ALL cases occur in adults, yet estimated 5-year overall survival rates are about 40% to 50%...

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Bibliographic Details
Published in:Blood reviews 2022-05, Vol.53, p.100908-100908, Article 100908
Main Authors: Douer, Dan, Gökbuget, Nicola, Stock, Wendy, Boissel, Nicolas
Format: Article
Language:English
Subjects:
Acute Disease
Acute lymphoblastic leukemia
Adult
Adults
Antineoplastic Agents - adverse effects
Asparaginase
Asparaginase - adverse effects
Efficacy
Humans
Incidence
Precursor Cell Lymphoblastic Leukemia-Lymphoma - drug therapy
Precursor Cell Lymphoblastic Leukemia-Lymphoma - epidemiology
Safety
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Summary:Acute lymphoblastic leukemia (ALL) is a malignancy of lymphoid progenitor cells occurring at an annual incidence rate of approximately 1.1 to 2.1 per 100,000 person-years globally. Approximately 40% of annual ALL cases occur in adults, yet estimated 5-year overall survival rates are about 40% to 50% in adults (and vary broadly by age) compared with 90% in children. Although the addition and/or intensification of asparaginase as a key treatment strategy for pediatric ALL is well recognized, further research is needed to clarify the benefit/risk ratio in adult patients with ALL. This review emphasizes the importance of efficient management of adverse events to increase asparaginase efficacy and explores novel strategies for optimizing asparaginase treatment, including new formulations of asparaginase, pharmacokinetic-based dosing, and pharmacogenetic profiling. Upcoming results of adult ALL trials should further clarify the role of asparaginase, building on the results of the large NOPHO 2008, CALGB 10403, GRAALL-2005, GMALL 07/2003, and UKALL14 trials.
ISSN:0268-960X
1532-1681
DOI:10.1016/j.blre.2021.100908