RESUMO
The efficacy of asparaginase in acute lymphoblastic leukemia (ALL) is dependent on depletion of asparagine, an essential amino acid for ALL cells. The target level of plasma asparaginase activity to achieve asparagine depletion has been between 0.05 and 0.4 IU/mL. COG AALL07P4 examined the asparaginase activity and plasma and CSF asparagine concentration of pegaspargase when given intravenously in the treatment of NCI high risk ALL. Matched plasma asparaginase/asparagine levels of the clearance of 54 doses of pegaspargase given in induction or consolidation demonstrated that all patients who had a plasma asparaginase level >0.02 IU/mL had undetectable plasma asparagine. No difference was observed in CSF asparagine levels associated with matched plasma asparaginase levels of 0.02-0.049 versus 0.05-0.22 IU/mL (p = .25). Our data suggest that a plasma asparaginase activity level of 0.02 IU/mL can effectively deplete plasma asparagine. The data also indicate that the 95% CI for plasma asparagine depletion after a pegaspargase dose is 22-29 days. Clinical trial registration: clinicaltrials.gov identifier NCT00671034.
Assuntos
Antineoplásicos/uso terapêutico , Asparaginase/sangue , Asparagina/líquido cefalorraquidiano , Biomarcadores Tumorais/análise , Polietilenoglicóis/uso terapêutico , Leucemia-Linfoma Linfoblástico de Células Precursoras/tratamento farmacológico , Adolescente , Adulto , Antineoplásicos/farmacocinética , Asparaginase/uso terapêutico , Asparagina/deficiência , Criança , Pré-Escolar , Feminino , Seguimentos , Humanos , Lactente , Masculino , Leucemia-Linfoma Linfoblástico de Células Precursoras/sangue , Leucemia-Linfoma Linfoblástico de Células Precursoras/líquido cefalorraquidiano , Leucemia-Linfoma Linfoblástico de Células Precursoras/patologia , Prognóstico , Distribuição Tecidual , Adulto JovemRESUMO
Depletion of nonessential amino acids and its effect on the immune system can be studied by the administration of bacterial enzymes. Escherichia coli asparaginase hydrolyzes both asparagine and glutamine: administration of this enzyme to mice is rapidly immunosuppressive. Vibrio succinogenes asparaginase hydrolyzes only asparagine and has no apparent effect on immune system function. When the enzymes are rendered nonantigenic and nonimmunogenic by covalent attachment of polyethylene glycol, the effects on immune system function remain the same as described above with the native (nonmodified) enzymes. We believe the data reviewed justify the conclusion that glutamine deficiency is specifically immunosuppressive whereas asparagine deficiency is not. We further believe that enzymatic depletion of nonessential amino acids can be a useful tool for nutritional investigations.