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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, Genevieve;
  • Yakouben, Karima;
  • Uyttebroeck, Anne; 58451;
  • Lutz, Patrick;
  • Costa, Vitor;
  • Sirvent, Nicolas;
  • Plouvier, Emmanuel;
  • Munzer, Martine;
  • Poiree, Maryline;
  • Minckes, Odile;
  • Millot, Frederic;
  • Plantaz, Dominique;
  • Maes, Philip;
  • Hoyoux, Claire;
  • Cave, Helene;
  • And 3 more
Publication Date
Jan 01, 2017
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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. This trial was registered at as #NCT00003728. / status: published

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