Review of L-Asparaginase Hypersensitivity in Pediatric ALL Patients

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Journal name: The Malaysian Journal of Medical Sciences
Original article title: A Review of L-Asparaginase Hypersensitivity in Paediatric Acute Lymphoblastic Leukaemia Patients with Regard to the Measurement of Anti-Asparaginase Antibodies and Their Genetic Predisposition
The Malaysian Journal of Medical Sciences (MJMS) is a peer-reviewed, open-access journal published online at least six times a year. It covers all aspects of medical sciences and prioritizes high-quality research.
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Original source:

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Author:

Yan Qi Tan, C-Khai Loh, Suzana Makpol


The Malaysian Journal of Medical Sciences:

(A peer-reviewed, open-access journal)

Full text available for: A Review of L-Asparaginase Hypersensitivity in Paediatric Acute Lymphoblastic Leukaemia Patients with Regard to the Measurement of Anti-Asparaginase Antibodies and Their Genetic Predisposition

Year: 2023 | Doi: 10.21315/mjms2023.30.5.4

Copyright (license): CC BY 4.0


Download the PDF file of the original publication


Summary of article contents:

Introduction

L-asparaginase is a critical component of the first-line treatment for childhood acute lymphoblastic leukaemia (ALL), although its use is associated with the development of hypersensitivity reactions in some patients. This hypersensitivity may significantly impair the therapeutic effectiveness of the drug, thereby negatively impacting the clinical outcomes for affected children. This paper explores the clinical implications of L-asparaginase hypersensitivity, examining the various types of antibodies produced against the drug, along with specific genetic polymorphisms that may contribute to an increased risk of such reactions.

Antibodies and Genetic Variants in L-Asparaginase Hypersensitivity

The hypersensitivity reactions to L-asparaginase can manifest both clinically and subclinically, often resulting in inactivation of the medication and decreased efficacy in treatment. Studies have demonstrated the presence of anti-asparaginase antibodies, primarily immunoglobulin G (IgG), immunoglobulin M (IgM), and immunoglobulin E (IgE), with conflicting evidence regarding the role of IgE. While IgG and IgM levels correlate with allergic reactions in some patients, the presence of these antibodies does not always predict treatment outcomes. Additionally, certain genetic variants have been identified that predispose patients to hypersensitivity, but relevant studies often focus more heavily on Caucasian populations, highlighting a knowledge gap regarding Asian patients where such genetic associations are less explored. The existing data regarding genetic polymorphisms suggests a significant role in the susceptibility to hypersensitivity reactions against L-asparaginase.

Conclusion

In summary, the hypersensitivity surrounding L-asparaginase presents a notable obstacle in improving treatment efficacy for childhood ALL. Understanding the mechanisms behind this immunogenic response, particularly through the lens of anti-asparaginase antibodies and genetic predispositions, is paramount for optimizing treatment strategies. Continued research in this field is essential, particularly focusing on diverse patient populations, to enhance the personalization of treatment regimens and improve overall survival rates for these pediatric patients. Addressing the current gaps in knowledge will be vital for future advancements in cancer therapy.

FAQ section (important questions/answers):

What is L-asparaginase and its role in childhood ALL treatment?

L-asparaginase is an enzymatic chemotherapy drug used as a first-line treatment for childhood acute lymphoblastic leukaemia (ALL). It works by reducing L-asparagine levels, which are essential for the uncontrolled proliferation of cancerous lymphoblasts.

What are the potential hypersensitivity reactions to L-asparaginase?

Hypersensitivity to L-asparaginase can cause allergic reactions, reducing the drug's efficacy and leading to suboptimal therapeutic outcomes. Clinical manifestations range from mild allergic reactions to severe hypersensitivity, affecting approximately 30% of patients receiving the native form.

How do antibodies relate to L-asparaginase hypersensitivity in patients?

Patients can develop antibodies such as IgG, IgM, and IgE against L-asparaginase. These antibodies can lead to hypersensitivity reactions, influencing the efficacy of the treatment. Notably, the presence of antibodies does not always correlate with treatment outcomes.

What are the genetic factors associated with L-asparaginase hypersensitivity?

Genetic polymorphisms in specific genes, such as GRIA1 and NFATC2, have been linked to increased susceptibility to L-asparaginase hypersensitivity. Understanding these variants can aid in tailoring treatment plans for affected children with ALL.

Glossary definitions and references:

Scientific and Ayurvedic Glossary list for “Review of L-Asparaginase Hypersensitivity in Pediatric ALL Patients”. This list explains important keywords that occur in this article and links it to the glossary for a better understanding of that concept in the context of Ayurveda and other topics.

1) Table:
A table is a structured arrangement of data, often used to present complex information clearly and systematically. In the context of research articles, tables compile results, statistics, or comparisons, making it easier for readers to understand study findings and draw conclusions about experimental results and data relationships without extensive textual explanations.

2) Blood:
Blood is a vital fluid in the human body, responsible for transporting oxygen, nutrients, hormones, and waste products. In medical studies, particularly regarding diseases like acute lymphoblastic leukemia (ALL), blood samples are often analyzed to assess patient health, disease progression, and the effects of treatments like L-asparaginase on leukemic cells.

3) Study (Studying):
Studying is the act of examining or investigating a subject systematically. In the context of medical research, studying various factors such as drug efficacy, patient responses, and disease mechanisms is vital for the advancement of medical knowledge and the development of better treatment strategies for diseases like acute lymphoblastic leukemia.

4) Cancer:
Cancer is a group of diseases characterized by uncontrolled cell division and growth. This condition can affect various tissues and organs in the body. Understanding cancer, especially childhood cancers like acute lymphoblastic leukemia (ALL), is critical for developing effective treatment strategies, including chemotherapy and targeted therapies to enhance survival rates.

5) Drug:
A drug is a chemical substance used to diagnose, treat, or prevent diseases. In the context of cancer treatment, drugs like L-asparaginase play a crucial role in targeting malignant cells. The effectiveness and safety of drugs need to be studied extensively to ensure beneficial patient outcomes while minimizing side effects.

6) Activity:
Activity in a medical context often refers to the biological effects or actions of a substance, such as how a drug interacts with cells or metabolic processes. Measuring the activity level of drugs like L-asparaginase is essential to evaluate therapeutic efficacy and ensure that sufficient drug levels are maintained during treatment.

7) Ter:
Ther could refer to therapeutic approaches or therapies employed in medical treatment. It evokes the idea of treatment modalities aimed at healing or managing health conditions, particularly in chronic illnesses such as cancer, where various therapies (chemotherapy, immunotherapy, etc.) are crucial for achieving remission and improving quality of life.

8) Line:
In a clinical context, 'line' typically describes the sequence of treatment courses (first-line, second-line therapy, etc.) offered to patients based on efficacy and patient response. For example, L-asparaginase is a first-line treatment for childhood acute lymphoblastic leukemia, emphasizing its importance in initial therapeutic strategies to combat the disease.

9) Disease:
A disease is a pathological condition characterized by a specific set of symptoms and dysfunctions. Understanding diseases like ALL is critical for developing targeted therapies and improving patient outcomes. Research in this area focuses on disease mechanisms, treatment responses, and the development of preventive strategies to enhance overall survival rates.

10) Allergy:
An allergy is an immune response to a substance (allergen) that the body mistakenly identifies as harmful. In the context of drug administration, such as L-asparaginase for ALL treatment, allergies can severely hinder treatment efficacy and safety, emphasizing the need for monitoring hypersensitivity reactions in patients during therapy.

11) Storm:
In the context of medical literature, Storm may refer to a variety of studies or findings, potentially relating to emotional or psychological turmoil associated with illness diagnosis and treatment regimens. However, in a specific research context, it may denote an actual study or research group's findings that need to be examined carefully.

12) Human body:
The human body is a complex organism comprising various systems that work together to maintain life. Understanding the human body's physiological responses to treatments, such as those against ALL, is vital for developing effective therapies. Knowledge of molecular pathways and immune responses can guide personalized treatment approaches tailored to individuals.

13) Toxicity:
Toxicity refers to the degree to which a substance can harm living organisms. In cancer treatment, assessing drug toxicity is critical, as cancer therapies, including L-asparaginase, can lead to adverse effects that may limit their usage or necessitate adjustments in dosing, hence affecting overall treatment efficacy and patient quality of life.

14) Rules:
Rules in a medical or research context may refer to guidelines established to govern study designs and protocols. These rules are essential for ensuring consistency and reliability in research findings, particularly in clinical trials, where adherence to established protocols helps protect patient safety and yields valid, reproducible results.

15) Carin (Cari):
The term Saari could refer to specific contributors or researchers associated with a study or publication. It highlights the importance of individual researchers' contributions in advancing scientific knowledge, particularly in complex fields like oncology, where collaborative efforts can lead to significant breakthroughs in understanding and treating childhood cancers.

16) Mast:
Mast cells are immune cells that play a crucial role in allergic responses and inflammation. They release histamines and other mediators upon activation. In the context of drug hypersensitivity, understanding mast cell involvement is vital to unravel the mechanisms underlying adverse reactions to therapies like L-asparaginase in pediatric patients.

17) Chemotherapy:
Chemotherapy is a type of cancer treatment that uses drugs to kill or slow the growth of cancer cells. It is often a primary treatment modality for conditions like ALL. The effectiveness and side effects of chemotherapy drugs need careful monitoring to ensure the best possible outcomes while managing adverse reactions.

18) Surface:
In a medical or laboratory context, 'surface' can refer to various applications, including surfaces of cells or materials in biochemical assays. Techniques like surface plasmon resonance (SPR) analyze molecular interactions on surfaces, enhancing the understanding of immune responses, including antibody interactions with treatments like L-asparaginase in cancer therapy.

19) Salina (Shalina):
The term Salina might refer to a researcher or study related to cancer treatment or drug efficacy, highlighting the role of various contributors in advancing medical knowledge. The contributions from individual researchers are essential for understanding complex biological interactions and improving treatment protocols in diseases like ALL.

20) Gupta:
The name Gupta potentially refers to a researcher involved in studies related to L-asparaginase, contributing to the understanding of drug hypersensitivity and genetic predispositions in pediatric leukemia treatments. Such contributions are vital for designing tailored therapies, enhancing efficacy, and minimizing adverse effects in patients undergoing chemotherapy.

21) Tori (Dhori):
Dori may represent an individual contributor to research efforts in the medical field, particularly in studying drug interactions and patient responses in cancer treatment. The integration of diverse research efforts from different individuals is critical for advancing the understanding of treatment mechanisms and improving clinical outcomes for patients.

22) Developing:
Developing refers to the process of creating or improving treatments and understanding disease mechanisms in medicine. In cancer research, developing better therapeutic strategies and optimizing treatment protocols based on individual responses can significantly enhance patient outcomes, particularly in treating acute lymphoblastic leukemia and managing its associated complications.

23) Knowledge:
Knowledge encompasses the understanding and information acquired through study and experience. In medical research, increasing knowledge about diseases, therapeutic agents, and patient responses is crucial for innovating treatments and enhancing patient care. This ongoing expansion of knowledge leads to improved survival rates and quality of life for patients.

24) Education:
Education refers to the process of imparting knowledge, skills, and understanding to individuals. In the medical field, education is fundamental for healthcare professionals to remain updated on treatment protocols, patient care strategies, and emerging research findings, ultimately enhancing their ability to provide evidence-based care to patients with conditions like acute lymphoblastic leukemia.

25) Suffering:
Suffering is the experience of pain, distress, or hardship that individuals may endure due to illness or adverse treatment effects. In the context of cancer patients, minimizing suffering through effective therapies, supportive care, and psychosocial interventions is essential for improving overall quality of life and facilitating better treatment adherence.

26) Vomiting:
Vomiting is a common adverse effect associated with many medical treatments, including chemotherapy. It can significantly impact patient comfort, adherence to treatment, and overall quality of life. Understanding the causes and mechanisms behind drug-induced vomiting is essential for developing supportive care strategies to alleviate this distressing symptom during cancer treatment.

27) Humana:
Humana may refer to a biomedical publishing company or researcher associated with the advancement of healthcare knowledge. Their role often includes producing valuable medical literature that contributes to understanding diseases and improving treatment options, particularly for conditions like ALL, thus influencing practice and patient care on a global scale.

28) Animal:
Animal studies are crucial in biomedical research for understanding physiological processes and testing drug responses before human trials. In cancer research, animal models help identify mechanisms behind drug efficacy, toxicity, and hypersensitivity reactions, ultimately aiding in the development of safe and effective treatments for human patients dealing with severe conditions.

29) Natan:
Nathan may refer to a researcher or contributor noted for their work in studying leukemia treatments or related medical research. Recognizing the contributions of various individuals emphasizes the collaborative nature of scientific research, which is essential for generating insights that improve therapy outcomes for diseases like acute lymphoblastic leukemia.

30) Hand:
In a medical context, hand may symbolize the meticulous work and care healthcare providers offer to patients. It underscores the significance of hands-on practice in treatment, including drug administration and patient monitoring, which are crucial in ensuring the safety and effectiveness of therapies in managing acute lymphoblastic leukemia.

31) Post:
Post could refer to a publication or an online update regarding ongoing research, findings, or treatment protocols. Engaging with current research can keep healthcare professionals informed about recent developments in cancer treatments, facilitating improved patient care and outcomes, particularly concerning therapies for childhood leukemia and their associated complications.

32) Pur:
Poor outcomes in medical contexts typically refer to unfavorable health results, often related to treatment response, adherence issues, or disease progression. In childhood leukemia, efforts are focused on minimizing poor outcomes through understanding patient responses and identifying genetic predispositions that affect treatment efficacy and survival rates.

33) Life:
Life represents the biological and experiential aspect of human existence. In medical research, preserving and enhancing the quality of life is a primary goal, especially for patients with diseases like acute lymphoblastic leukemia. Understanding treatment effects can help improve survival and quality of life, making ongoing research essential.

Other Science Concepts:

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Discover the significance of concepts within the article: ‘Review of L-Asparaginase Hypersensitivity in Pediatric ALL Patients’. Further sources in the context of Science might help you critically compare this page with similair documents:

Elisa, Chemotherapy, Human body, Blood circulation, Bone marrow, Immune system, Treatment regimen, Human subjects, Clinical trial, Treatment Protocol, Patient Monitoring, Treatment outcome, Drug administration, Gene expression, Clinical manifestation, IgE antibodies, Antibody formation, Single nucleotide polymorphism, Drug efficacy, Hypersensitivity reaction, Pharmacokinetic properties, Amino acid, Enzyme-linked immunosorbent assay, Surface plasmon resonance, Mechanisms of action, Cancer treatment, E. coli, ALLERGIC REACTION, First line treatment, B-lymphocytes, IgE, Clinical outcome, Intravenous route, Acute lymphoblastic leukemia, Dosing frequency, Survival rate, Genetic polymorphism, Overall survival, ELISA technique, Antibody, Intramuscular Route, Genetic variants, IgM antibodies, IgG antibodies, Anti-asparaginase antibodies, Genome-wide association study, Allele frequencies, L-Asparaginase, Acute lymphoblastic leukaemia, Antigen binding site, Immune-mediated reaction, Murine model, Antibody Levels, Medical resources, Antibody production, Gene Knock out, Plasma level, Chemotherapeutic drug, B cell receptor, Molecular pathways, Blast cells, Gene polymorphism, Preclinical animal studies, Asian population, Plasma cell, Childhood ALL, Patient age, ELISA assay.

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