L-asparaginase treatment in acute lymphoblastic leukemia

Rob Pieters, Stephen P. Hunger, Joachim Boos, Carmelo Rizzari, Lewis Silverman, Andre Baruchel, Nicola Goekbuget, Martin Schrappe, Ching Hon Pui

Research output: Contribution to journalReview articlepeer-review

446 Scopus citations


Asparaginases are a cornerstone of treatment protocols for acute lymphoblastic leukemia (ALL) and are used for remission induction and intensification treatment in all pediatric regimens and in the majority of adult treatment protocols. Extensive clinical data have shown that intensive asparaginase treatment improves clinical outcomes in childhood ALL. Three asparaginase preparations are available: the native asparaginase derived from Escherichia coli (E. coli asparaginase), a pegylated form of this enzyme (PEG-asparaginase), and a product isolated from Erwinia chrysanthemi, ie, Erwinia asparaginase. Clinical hypersensitivity reactions and silent inactivation due to antibodies against E. coli asparaginase, lead to inactivation of E. coli asparaginase in up to 60% of cases. Current treatment protocols include E. coli asparaginase or PEG-asparaginase for first-line treatment of ALL. Typically, patients exhibiting sensitivity to one formulation of asparaginase are switched to another to ensure they receive the most efficacious treatment regimen possible. Erwinia asparaginase is used as a second- or third-line treatment in European and US protocols. Despite the universal inclusion of asparaginase in such treatment protocols, debate on the optimal formulation and dosage of these agents continues. This article provides an overview of available evidence for optimal use of Erwinia asparaginase in the treatment of ALL.

Original languageEnglish
Pages (from-to)238-249
Number of pages12
Issue number2
StatePublished - 15 Jan 2011
Externally publishedYes


  • ALL
  • Erwinase
  • Erwinia asparaginase
  • acute lymphoblastic leukemia
  • asparaginase
  • asparagine depletion


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