title: [Update on L-asparaginase treatment in paediatrics].
abstract: L-asparaginase (L-ASP) is one of the cornerstones of the treatment of acute lymphoblastic leukemia and non-Hodgkin lymphoma. It is an enzyme of bacterial origin capable of transforming L-asparagine to aspartic acid. The extracellular depletion of L-asparagine inhibits protein synthesis in lymphoblasts, inducing their apoptosis. Numerous studies have demonstrated that treatment with L-ASP improves survival of patients, but there are clear differences in the characteristics of the three currently available formulations. This article reviews the dosage, activity and side effects of the two L-ASP derived from Escherichia coli (native and pegylated), and the one derived from Erwinia chrysanthemi (Erwinia ASP). Despite its indisputable indication over the past50 years, there are still many points of contention, and its use is still marked by the side effects of the inhibition of protein synthesis. The short half-life of native forms, and the most frequently used parenteral administration by intramuscular injections, affects the quality of life of the patients. Therefore, recent studies claim to evaluate alternatives, such as the formulation of longer half-life pegylated L-ASP, and the use of intravenous formulations. There are encouraging results to date with both preparations. Still, further studies are needed to establish which should be the formulation and frontline indicated route of administration, optimal dosing, and management of adverse effects.
authors.affiliation: Hospital General Universitario, Alicante, España.
authors.forename: C
authors.initials: C
authors.lastname: Moscardó Guilleme
authors.forename: R
authors.initials: R
authors.lastname: Fernández Delgado
authors.forename: J
authors.initials: J
authors.lastname: Sevilla Navarro
authors.forename: I
authors.initials: I
authors.lastname: Astigarraga Aguirre
authors.forename: S
authors.initials: S
authors.lastname: Rives Solà
authors.forename: J
authors.initials: J
authors.lastname: Sánchez de Toledo Codina
authors.forename: J L
authors.initials: JL
authors.lastname: Fuster Soler
authors.forename: L
authors.initials: L
authors.lastname: Parra Ramirez
authors.forename: J
authors.initials: J
authors.lastname: Molina Garicaño
authors.forename: B
authors.initials: B
authors.lastname: González Martínez
authors.forename: L
authors.initials: L
authors.lastname: Madero López
mesh_terms: D000970:Antineoplastic Agents / Q000627:therapeutic use*; D001215:Asparaginase / Q000627:therapeutic use*; D002648:Child; D006801:Humans; D008228:Lymphoma, Non-Hodgkin / Q000188:drug therapy*; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000188:drug therapy*
chemical_list: D000970:Antineoplastic Agents; D001215:Asparaginase
keywords: Acute Lymphoblastic Leukemia; Asparaginase; Asparraginasa; Asparraginasa de Erwinia: asparraginasa de Escherichia coli pegilada; Asparraginasa de Escherichia coli nativa; Erwinia Asparaginase; Escherichia coli Asparaginase; Hodgkin lymphoma; Leucemia linfoblástica aguda; Linfoma de Hodgkin; Pegylated Asparaginase