Asparaginase activity levels and monitoring in patients with acute lymphoblastic leukemia

Abstract

Asparaginase is an integral component of multiagent chemotherapy regimens for the treatment of acute lymphoblastic leukemia (ALL). Adequate asparagine depletion is believed to be an important factor in achieving optimal therapeutic outcomes. Measurement of asparaginase activity allows practitioners to evaluate the potential effectiveness of therapy in real time. Asparaginase activity levels can be used to identify patients with silent inactivation and modify therapy in these patients. Patients with silent inactivation to asparaginase who are switched to therapy with an immunologically distinct asparaginase exhibit outcomes similar to patients who never developed silent inactivation. Despite these benefits, there exists no universally agreed-upon guideline for treatment adjustments based on asparaginase activity levels. The goal of this manuscript is to review the clinical evidence linking asparaginase activity levels to outcomes in patients with ALL and to provide an overview of how asparaginase activity levels may be used to guide treatment.

Keywords:

• Acute lymphoblastic leukemia
• asparaginase
• hypersensitivity
• silent inactivation
• activity level monitoring

Acknowledgements

Under the direction of the authors, Cory Hussar, PhD, of The Curry Rockefeller Group, LLC (CRG), Tarrytown, NY, provided medical writing assistance for this publication. Editorial assistance in formatting, proofreading, copy editing, and fact checking was also provided by CRG. Jazz Pharmaceuticals, Inc, provided funding to CRG for support in writing and editing of this publication.

Potential conflict of interest

Disclosure forms provided by the authors are available with the full text of this article online at https://doi.org/10.1080/10428194.2017.1386305.

Additional information

Funding

This publication was supported by Jazz Pharmaceuticals, Inc.