Catalyzing improvements in ALL therapy with asparaginase

Bernard L Marini; Anthony J Perissinotti; Dale L Bixby; Julia Brown; Patrick W Burke

doi:10.1016/j.blre.2017.06.002

Catalyzing improvements in ALL therapy with asparaginase

Blood Rev. 2017 Sep;31(5):328-338. doi: 10.1016/j.blre.2017.06.002. Epub 2017 Jul 5.

Authors

Bernard L Marini¹, Anthony J Perissinotti², Dale L Bixby³, Julia Brown⁴, Patrick W Burke⁵

Affiliations

¹ Department of Pharmacy Services and Clinical Sciences, University of Michigan Health System and College of Pharmacy, 1111 E. Catherine St., Ann Arbor, MI 48109, USA. Electronic address: bernmari@med.umich.edu.
² Department of Pharmacy Services and Clinical Sciences, University of Michigan Health System and College of Pharmacy, 1111 E. Catherine St., Ann Arbor, MI 48109, USA. Electronic address: ajperis@med.umich.edu.
³ Department of Internal Medicine, Division of Hematology/Oncology, University of Michigan C.S. Mott Children's Hospital, 1540 E Hospital Dr, Ann Arbor, MI 48109, USA. Electronic address: dbixby@med.umich.edu.
⁴ Department of Pharmacy Services and Clinical Sciences, University of Michigan Health System and College of Pharmacy, 1111 E. Catherine St., Ann Arbor, MI 48109, USA. Electronic address: brownjdb@med.umich.edu.
⁵ Department of Internal Medicine, Division of Hematology/Oncology, University of Michigan C.S. Mott Children's Hospital, 1540 E Hospital Dr, Ann Arbor, MI 48109, USA. Electronic address: pwburke@med.umich.edu.

PMID: 28697948
DOI: 10.1016/j.blre.2017.06.002

Abstract

Asparaginase remains a cornerstone of ALL therapy and is one of the key contributing factors to improved outcomes in adolescent and young adult (AYA) patients treated on pediatric protocols. Asparagine depletion has been associated with improved outcomes in ALL patients; this has led to an increased emphasis on optimizing asparagine depletion in ALL patients of all ages. To ensure adequate asparagine depletion, the use of therapeutic drug monitoring of asparaginase therapy holds much promise, yet remains underutilized in practice. Data regarding asparaginase activity level monitoring and associated outcomes are reviewed, and an evidence-based asparaginase activity level monitoring algorithm is presented. Finally, unique management strategies for key asparaginase toxicities in ALL patients are discussed, as well as a discussion of novel asparaginase formulations on the horizon.

Keywords: ALL; AYA; Asparaginase; Therapeutic drug monitoring.

Publication types

Review

MeSH terms

Antineoplastic Agents / pharmacology
Antineoplastic Agents / therapeutic use*
Asparaginase / pharmacology
Asparaginase / therapeutic use*
Cost-Benefit Analysis
Disease Management
Drug Compounding
Drug Discovery
Drug Monitoring
Humans
Precursor Cell Lymphoblastic Leukemia-Lymphoma / drug therapy*
Precursor Cell Lymphoblastic Leukemia-Lymphoma / metabolism*
Treatment Outcome

Substances

Antineoplastic Agents
Asparaginase