Research
Print page Print page
Switch language
The Capital Region of Denmark - a part of Copenhagen University Hospital
E-pub ahead of print

Relapse risk following truncation of PEG-asparaginase in childhood acute lymphoblastic leukemia

Research output: Contribution to journalJournal articleResearchpeer-review

DOI

  1. Higher-order connections between stereotyped subsets: implications for improved patient classification in CLL

    Research output: Contribution to journalJournal articleResearchpeer-review

  2. Cost-effectiveness targeting CLL

    Research output: Contribution to journalJournal articleResearchpeer-review

  3. Novel manifestations of immune dysregulation and granule defects in gray platelet syndrome

    Research output: Contribution to journalJournal articleResearchpeer-review

  4. Sirolimus with CSP and MMF as GVHD prophylaxis for allogeneic transplantation with HLA antigen-mismatched donors

    Research output: Contribution to journalJournal articleResearchpeer-review

  1. PREVALENCE OF SARS-COV-2-ANTIBODIES IN DANISH CHILDREN AND ADULTS

    Research output: Contribution to journalJournal articleResearchpeer-review

  2. A qualitative study of adolescent cancer survivors perspectives on social support from healthy peers - A RESPECT study

    Research output: Contribution to journalJournal articleResearchpeer-review

  3. Home-based cognitive behavioural therapy for families of young children with cancer (FAMOS): A nationwide randomised controlled trial

    Research output: Contribution to journalJournal articleResearchpeer-review

  4. National, clinical cohort study of late effects among survivors of acute lymphoblastic leukaemia: the ALL-STAR study protocol

    Research output: Contribution to journalJournal articleResearchpeer-review

View graph of relations

Truncation of asparaginase treatment due to asparaginase related toxicities or silent inactivation (SI) is common and may increase relapse risk in acute lymphoblastic leukemia (ALL). We investigated relapse risk following suboptimal asparaginase exposure among 1401 children aged 1-17 years, diagnosed with ALL between July 2008 and February 2016, and treated according to the NOPHO ALL2008 protocol including extended asparaginase exposure (1,000 IU/m2 intramuscularly weeks 5 to 33). Patients were included with delayed entry at their last administered asparaginase treatment or detection of SI and followed until relapse, death, secondary malignancy, or end of follow-up (median: 5.71 years, interquartile range: 4.02-7.64). In a multiple Cox model comparing patients with (n=358) and without (n=1043) truncated asparaginase treatment due to clinical toxicity, the adjusted relapse-specific hazard ratio (aHR) was 1.33 (95% confidence interval [CI]: 0.86-2.06, P=0.20). In a substudy including only patients with information on enzyme activity (n=1115), the 7-year cumulative incidence of relapse for the 301 patients with truncation of asparaginase treatment or SI (157 hypersensitivity, 53 pancreatitis, 14 thrombosis, 31 other, 46 SI) was 11.1% (95% CI: 6.9-15.4) versus 6.7% (95% CI: 4.7-8.6) for the 814 remaining patients. The relapse-specific aHR was 1.69 (95% CI: 1.05-2.74, P=0.03). The unadjusted bone-marrow relapse-specific HR was 1.83 (95% CI: 1.07-3.14, P=0.03) and 1.86 (95% CI: 0.90- 3.87, P=0.095) for any CNS relapse. These results emphasize the importance of therapeutic drug monitoring and appropriate adjustment of asparaginase therapy when feasible.

Original languageEnglish
JournalBlood
ISSN0006-4971
DOIs
Publication statusE-pub ahead of print - 2021

ID: 61695792