Salzer Wanda, Bostrom Bruce, Messinger Yoav, Perissinotti Anthony J, Marini Bernard
a U.S. Army, Medical Research and Materiel Command , Fort Detrick , MD , USA.
b Children's of Minnesota , Minneapolis , MN , USA.
Leuk Lymphoma. 2018 Aug;59(8):1797-1806. doi: 10.1080/10428194.2017.1386305. Epub 2017 Oct 18.
Asparaginase is an integral component of multiagent chemotherapy regimens for the treatment of acute lymphoblastic leukemia (ALL). Adequate asparagine depletion is believed to be an important factor in achieving optimal therapeutic outcomes. Measurement of asparaginase activity allows practitioners to evaluate the potential effectiveness of therapy in real time. Asparaginase activity levels can be used to identify patients with silent inactivation and modify therapy in these patients. Patients with silent inactivation to asparaginase who are switched to therapy with an immunologically distinct asparaginase exhibit outcomes similar to patients who never developed silent inactivation. Despite these benefits, there exists no universally agreed-upon guideline for treatment adjustments based on asparaginase activity levels. The goal of this manuscript is to review the clinical evidence linking asparaginase activity levels to outcomes in patients with ALL and to provide an overview of how asparaginase activity levels may be used to guide treatment.
天冬酰胺酶是治疗急性淋巴细胞白血病（ALL）的多药化疗方案的一个重要组成部分。充足的天冬酰胺消耗被认为是实现最佳治疗效果的一个重要因素。天冬酰胺酶活性的测定使医生能够实时评估治疗的潜在效果。天冬酰胺酶活性水平可用于识别无明显失活的患者，并对这些患者的治疗进行调整。对天冬酰胺酶无明显失活而改用免疫特性不同的天冬酰胺酶治疗的患者，其治疗效果与从未发生明显失活的患者相似。尽管有这些益处，但目前尚无基于天冬酰胺酶活性水平进行治疗调整的普遍认可的指南。本手稿的目的是综述将天冬酰胺酶活性水平与ALL患者治疗效果相关联的临床证据，并概述天冬酰胺酶活性水平如何用于指导治疗。
