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Prolonged versus standard native E-coli asparaginase therapy in childhood acute lymphoblastic leukemia and non-Hodgkin lymphoma : final results of the EORTC-CLG randomized phase III trial 58951

  • Mondelaers, Veerle
  • Suciu, Stefan
  • De Moerloose, Barbara
  • Ferster, Alina
  • Mazingue, Francoise
  • Plat, Geneviève
  • Yakouben, Karima
  • Uyttebroeck, Anne
  • Lutz, Patrick
  • Costa, Vitor
  • Sirvent, Nicolas
  • Plouvier, Emmanuel
  • Munzer, Martine
  • Poirée, Maryline
  • Minckes, Odile
  • Millot, Frédéric
  • Plantaz, Dominique
  • Maes, Philip
  • Hoyoux, Claire
  • Cavé, Hélène
  • And 3 more
Publication Date
Jan 01, 2017
Ghent University Institutional Archive
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Asparaginase is an essential component of combination chemotherapy for childhood acute lymphoblastic leukemia and non-Hodgkin lymphoma. The value of asparaginase was further addressed in a group of non-very high-risk patients by comparing prolonged (long-asparaginase) versus standard (short-asparaginase) native E. coli asparaginase treatment in a randomized part of the phase III 58951 trial of the European Organization for Research and Treatment of Cancer Children's Leukemia Group. The main endpoint was disease-free survival. Overall, 1,552 patients were randomly assigned to long-asparaginase (775 patients) or short-asparaginase (777 patients). Patients with grade >= 2 allergy to native E. coli asparaginase were switched to equivalent doses of Erwinia or pegylated E. coli asparaginase. The 8-year disease-free survival rate (+/- standard error) was 87.0 +/- 1.3% in the long-asparaginase group and 84.4 +/- 1.4% in the short-asparaginase group (hazard ratio: 0.87; P=0.33) and the 8-year overall survival rate was 92.6 +/- 1.0% and 91.3 +/- 1.2% respectively (hazard ratio: 0.89; P=0.53). An exploratory analysis suggested that the impact of long-asparaginase was beneficial in the National Cancer Institute standard-risk group with regards to disease-free survival (hazard ratio: 0.70; P=0.057), but far less so with regards to overall survival (hazard ratio: 0.89). The incidences of grade 3-4 infection during consolidation (25.2% versus 14.4%) and late intensification (22.6% versus 15.9%) and the incidence of grade 2-4 allergy were higher in the long-asparaginase arm (30% versus 21%). Prolonged native E. coli asparaginase therapy in consolidation and late intensification for our non-very high-risk patients did not improve overall outcome but led to an increase in infections and allergy.

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