Clinical Application Of Pegaspargase In Children With Acute Lymphoblastic Leukemia And Significance Of Its Activities’ Change

Objective To compare the application of induction chemotherapy of pegaspargase(PEG-Asp) and L-asparaginase(L-Asp) in children with acute lymphoblastic leukemia(ALL), and significance of its activities’ change in vitro.Methods One hundred and twenty-four cases diagnosed acute lymphoblastic leukemia(ALL) were enrolled in this study from January 2014 to December 2014. 51 patients were received pegaspargase and 73 patients were received L-asparaginase, evaluation of adverse effects and efficacy of the two groups in inducing chemotherapy. Fifteen cases were diagnosed of acute lymphoblastic leukemia(ALL) from June 2015 to December 2015, all of them were in the use of domestic pegaspargase D1 and D15 days, pegaspargase activity and substrate concentration monitoring.Results(1)A total of 124 cases were enrolled in our clinical research, two groups of newly diagnosed children have similar incidence of adverse reactions in allergic reaction, abnormal liver function, acute pancreatitis, thrombosis, joint pain and gastrointestinal reaction, the difference was not statistically significant(P >0.05).(2)PEG-Asp group have higher incidence of abnormal coagulation function and incidence of hypoproteinemia; compare with L-Asp group, APTT, PT extension and FIB, AT-III decreased significantly increased incidence rate, the difference of two groups have statistically significant(P <0.05); both PEG-Asp group and L-Asp group, APTT, PT were mainly 1 barriers, FIB were 2, 3 barriers.(3)51 cases were enrolled in PEG-Asp group, 90.2% of complete remission rate, 94.1% of total effective rate; 73 cases were enrolled in L-Asp group, 91.8% of complete remission rate, 94.5% of total effective rate, there was no significant difference between the two groups(P﹦0.929).(4)In the induction therapy, the mean value of serum PEG-Asp activity in D1 days was 289.27 + 260.193IU/L, D15 was 466.20 + 273.978IU/L(the minimum threshold value 75 IU/L); D1, D15 serum ASN substrate concentrations were lower than the minimum threshold value(150ng/ml).Conclusion(1) There was no difference in the effect of induction chemotherapy in children with ALL between PEG-Asp and L-Asp;(2)Compared with the L-Asp group, the PEG-Asp group had a higher incidence of abnormal coagulation function and hypoproteinemia;(3)Evaluation of the changes of PEG-Asp’s activity and substrate concentration can be used as a basis for monitoring therapeutic potency.