Scholarlink

<p>Asparaginase is a cornerstone of pediatric acute lymphoblastic leukemia (ALL) therapy, but treatment discontinuation due to toxicity may increase relapse risk and compromise outcomes. We retrospectively analyzed 993 pediatric ALL patients (aged 1.0–17.9 years) treated under the CCCG-ALL-2015 protocol from May 2015 to October 2020. Patients were followed from the last administered asparaginase dose until relapse, death, secondary malignancy (SMN), or end of follow-up (median: 6.0 years). Asparaginase was truncated in 40 (4.0%) patients, primarily due to hypersensitivity or pancreatitis. Compared to non-truncated patients (<i>n</i> = 953), truncated patients had a higher 6-year cumulative incidence of relapse (CIR: 31.5% vs. 17.5%, HR: 2.01, <i>P</i> = .038), as well as inferior event-free survival (EFS) (HR: 2.11, <i>P</i> = .015) and overall survival (OS) (HR: 2.74, <i>P</i> = .046). CIR was also significantly higher among patients receiving &lt; 53% of planned asparaginase doses (32.1% vs. 14.0%, HR: 2.71, <i>P</i> = .004). In intermediate-risk subgroup, truncation was associated with significantly reduced EFS (HR: 1.95, <i>P</i> = .046). Older age (≥ 10 years), higher MRD levels (day 19 ≥ 0.1%), and higher asparaginase exposure percentage were predictors of discontinuation. In conclusion, asparaginase discontinuation is associated with inferior outcomes, emphasizing the importance of replacement with alternative formulations to maintain treatment intensity.</p>

错误：搜索内容不能为空，请输入英文关键词
错误：关键词超出字数限制，请精简
高级检索

Relapse risk and outcome of discontinuing asparaginase in children with acute lymphoblastic leukemia

  • 期刊论文

  • 出版模式：

    开放获取

  • 发表日期：

    2025年11月4日

查看全文
  • Xingchen Wang,
  • Chenmeng Liu,
  • Yunlong Chen,
  • Junxia Wang,
  • Yang Wan,
  • Wenbin An,
  • Xiaolan Li,
  • Lipeng Liu,
  • Fang Liu,
  • Tianyuan Hu,
  • Yingchi Zhang,
  • Li Zhang,
  • Yao Zou,
  • Xiaojuan Chen,
  • Yumei Chen,
  • Ye Guo,
  • Xiaofan Zhu,
  • Wenyu Yang

摘要

Asparaginase is a cornerstone of pediatric acute lymphoblastic leukemia (ALL) therapy, but treatment discontinuation due to toxicity may increase relapse risk and compromise outcomes. We retrospectively analyzed 993 pediatric ALL patients (aged 1.0–17.9 years) treated under the CCCG-ALL-2015 protocol from May 2015 to October 2020. Patients were followed from the last administered asparaginase dose until relapse, death, secondary malignancy (SMN), or end of follow-up (median: 6.0 years). Asparaginase was truncated in 40 (4.0%) patients, primarily due to hypersensitivity or pancreatitis. Compared to non-truncated patients (n = 953), truncated patients had a higher 6-year cumulative incidence of relapse (CIR: 31.5% vs. 17.5%, HR: 2.01, P = .038), as well as inferior event-free survival (EFS) (HR: 2.11, P = .015) and overall survival (OS) (HR: 2.74, P = .046). CIR was also significantly higher among patients receiving < 53% of planned asparaginase doses (32.1% vs. 14.0%, HR: 2.71, P = .004). In intermediate-risk subgroup, truncation was associated with significantly reduced EFS (HR: 1.95, P = .046). Older age (≥ 10 years), higher MRD levels (day 19 ≥ 0.1%), and higher asparaginase exposure percentage were predictors of discontinuation. In conclusion, asparaginase discontinuation is associated with inferior outcomes, emphasizing the importance of replacement with alternative formulations to maintain treatment intensity.