Cancer Res Treat.  2018 Jul;50(3):670-680. 10.4143/crt.2017.051.

Comparison of Native Escherichia coli L-Asparaginase versus Pegylated Asparaginase, in Combination with Ifosfamide, Methotrexate, Etoposide, and Prednisolone, in Extranodal NK/T-Cell Lymphoma, Nasal Type

Affiliations
  • 1Department of Pharmacy, Seoul National University Hospital, Seoul, Korea.
  • 2Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea. gabriel9@snu.ac.kr
  • 3Seoul National University Cancer Research Institute, Seoul, Korea.
  • 4College of Pharmacy and Institute of Pharmaceutical Science and Technology, Hanyang University, Guri, Korea.
  • 5Department of Radiation Oncology, Seoul National University Hospital, Seoul, Korea.

Abstract

PURPOSE
The aim of this study was to compare asparaginase-related toxicities in two asparaginase preparations, namely native Escherichia coli L-asparaginase (L-ASP) and pegylated asparaginase (PEG-ASP) in combination with ifosfamide, methotrexate, etoposide, and prednisolone (IMEP) in natural killer (NK)/T-cell lymphoma (NTCL).
MATERIALS AND METHODS
A total of 41 NTCL patients who received IMEP plus native E. coli L-ASP or PEG-ASP at Seoul National University Hospital were included in this study between January 2013 and March 2016. IMEP/ASP treatment consisted of ifosfamide, methotrexate, etoposide, plus native E. coli L-ASP (6,000 IU/m2 on days 1, 3, 5, 7, 9, and 11) or PEG-ASP (2,500 IU/m2 on day 1) every 3 weeks. ASP-related toxicities, toxicity patterns, length of hospital stay, and clinical outcomes were compared between the different treatment groups.
RESULTS
The frequency of ASP-related toxicities was similar between the IMEP plus native E. coli L-ASP group and the PEG-ASP group apart from hypofibrinogenemia (native E. coli L-ASP vs. PEG-ASP group, 86.4% vs. 36.8%; p=0.001). Although post-treatment transaminase and albumin levels were significantly high and low, respectively, hepatotoxicity gradients before and after treatment did not differ significantly between the groups. Since PEG-ASP was given at an outpatient clinic in some patients, length of hospital stay was significantly shorter in the IMEP plus PEG-ASP group (median, 4.0 vs. 6.0 days; p=0.002). A favorable tendency of clinical outcomes was observed in NTCL patients treated with IMEP plus PEG-ASP (complete remission rate, 73.7% vs. 45.5%; p=0.067).
CONCLUSION
IMEP plus PEG-ASP showed similar ASP-related toxicities, shorter length of hospital stay, and a trend towards improved clinical outcomes compared with IMEP plus native E. coli L-ASP in NTCL.

Keyword

NK/T-cell lymphoma; Native Escherichia coli L-asparaginase; Pegylated asparaginase; Toxicity; Length of stay

MeSH Terms

Ambulatory Care Facilities
Asparaginase*
Escherichia coli*
Escherichia*
Etoposide*
Humans
Ifosfamide*
Length of Stay
Lymphoma*
Methotrexate*
Prednisolone*
Seoul
Asparaginase
Etoposide
Ifosfamide
Methotrexate
Prednisolone
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