Pegylated Asparaginase In Combination With Vincristine,Daunorubicin and Prednisone For Remission Induction In Adult Acute Lymphoblastic Leukaemia

In contrast to that in children, the use of pegylated asparaginase in adult is very limited. We accept twenty-four newly diagnosed adult acute lymphoblastic leukemia (ALL) patients. Use pegylated asparaginase in combination with vincristine,daunorubicin and prednisone for remission induction. Pegylated asparaginase (Heng Rui Pharmaceuticals) administered at a dose of 2000 IU/m² (maximum dose 3750 IU) intramuscular on day 10, 24. The aim was to observe complete response (CR) rate and side effect of the regimen. The overall CR rate was 91.67% (22/24), including 19 patients who were in CR after phase 1 of induction. 1 patient failed to achieve CR, and died of septicemia on day 24 of induction therapy. 1 Ph⁺ ALL patient got CR after Imatinib added. Grade 3 or 4 hematological adverse effects were seen in 100% patients. Most non-hematological adverse effects were grade 1or 2, including vomiting and nausea (87.5%), infection (66.7%), liver disfunction (50%), diarrhea (12.5) and pancreatitis (4.1%). No allergic reactions were observed. The level of fibrinogen and AT III descended in all patients, including 7 patients fibrinogen less than 1.0g/L, 14 patients AT III less than 50%. But no patient developed evidence of bleeding or thrombosis. This regimen got a satisfactory CR rate in adult ALL and was safe with few grade 3/4 side effects. Pegylated asparaginase was well tolerated, no allergic reactions evidence of bleeding or thrombosis was observed.