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Published online: 27 April 2019
© Springer Nature Switzerland AG 2019
Abstract
Pegaspargase (Oncaspar®), a pegylated form of native Escherichia coli-derived L-asparaginase (hereafter referred as E. coli L-asparaginase), is indicated in the USA and EU for the treatment of acute lymphoblastic leukaemia (ALL) as a component of multi-agent chemotherapy in paediatric and adult patients. Relative to E. coli L-asparaginase, pegaspargase has a prolonged circulation time, thereby offering less frequent administration. Moreover, pegylation of E. coli L-asparaginase may diminish the immunogenicity of the enzyme. Based on extensive evidence, intramuscular (IM) or intravenous (IV) administration of pegaspargase as a component of a multi-agent chemotherapy is an effective first-line treatment for paediatric and adult patients with ALL, as well as for the treatment of paediatric and adult patients with ALL and hypersensitivity to E. coli L-asparaginase. Pegaspargase had a manageable tolerability profile in paediatric and adult patients with newly diagnosed ALL, with the most commonly occurring adverse events being generally consistent to that seen with E. coli L-asparaginase. Pegaspargase treatment in patients with relapsed ALL and hypersensitivity to E. coli L-asparaginase had a similar tolerability profile to that observed in patients with newly diagnosed ALL. Given the potentially reduced immunogenicity and more convenient dosage regimen over E. coli L-asparaginase, pegaspargase remains an important and effective treatment option for paediatric and adult patients with ALL, including those with hypersensitivity to E. coli L-asparaginase.
1 Introduction
Acute lymphoblastic leukaemia (ALL) is a heterogeneous haematological malignancy that occurs mainly in children (median age at diagnosis 15 years); however, ALL in adults accounts for 20% of all leukaemia cases [1]. ALL is typically characterized by the proliferation of large number of immature lymphoid cells in the bone marrow, peripheral blood and other organs. With an improved understanding of the pathogenesis of ALL and the recent advances in targeted therapies, the rates of complete remission (CR) and overall survival (OS) in patients with ALL have improved significantly, primarily in the paediatric population. Indeed, 5-year OS in children with ALL is 86-89%, with the rate declining with increased age (OS in adults 41% [2]) [1].
The treatment of ALL includes long-term use of multiagent chemotherapy [1, 2], of which asparaginase is a cornerstone component [2, 3]. Asparagine is a nonessential amino acid for...