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<p>Acute lymphoblastic leukemia (ALL) is the most common childhood cancer, with high cure rates in optimum situation, but suboptimal outcomes in resource-limited settings. L-asparaginase (L-Asp), a cornerstone drug of ALL, has effectiveness limited by interpatient variability due to antibody-mediated inactivation. Minimal residual disease (MRD) is an important marker for treatment response and overall outcome in ALL. However, data linking serum L-Asp activity to MRD are limited. This study assessed the association between serum L-Asp activity on Day 7 and 14 post-administration and end-of-induction (EOI) MRD in pediatric ALL. Sixty newly diagnosed pediatric ALL patients treated under ICiCLe protocol from September 2023 to April 2025 were included. Serum L-Asp activity was measured by colorimetry on Day 7 and 14. MRD at EOI was assessed by flow cytometry. Statistical analysis included Fisher-exact, Chi-square, Mann-Whitney U, multivariable logistic regression and Kaplan-Meier survival analysis. Of the 60 patients enrolled, 56 were evaluable. Optimal serum L-Asp activity was achieved in 75% on Day 7 and 60.7% on Day 14. No significant association was observed between serum L-Asp activity status at Day 7 or 14 and MRD at EOI. However, the rate of decrement in L-Asp level between Day 7 and 14 was significantly associated with MRD status (<i>P</i> &lt; 0.05). Although L-Asp status at Day 7 and 14 did not correlate with MRD at EOI, the trend in drug-level reduction between Day 7 and 14 was significantly associated with MRD status. Dynamic L-Asp monitoring may thus better predict MRD status at EOI in pediatric ALL.</p>

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The Effect of L-asparaginase Level Monitoring on Minimal Residual Disease of Childhood Acute Lymphoblastic Leukaemia: A Study from Eastern India

  • 期刊论文

  • 发表日期：

    2026年3月24日

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  • Praveen Kumar Jha,
  • Bijurica Chakraborty,
  • Stuti Roy,
  • Sounik Sarkar,
  • Abhishek Sharma,
  • Tuphan Kanti Dolai,
  • Praveen Kumar,
  • Rajib De

摘要

Acute lymphoblastic leukemia (ALL) is the most common childhood cancer, with high cure rates in optimum situation, but suboptimal outcomes in resource-limited settings. L-asparaginase (L-Asp), a cornerstone drug of ALL, has effectiveness limited by interpatient variability due to antibody-mediated inactivation. Minimal residual disease (MRD) is an important marker for treatment response and overall outcome in ALL. However, data linking serum L-Asp activity to MRD are limited. This study assessed the association between serum L-Asp activity on Day 7 and 14 post-administration and end-of-induction (EOI) MRD in pediatric ALL. Sixty newly diagnosed pediatric ALL patients treated under ICiCLe protocol from September 2023 to April 2025 were included. Serum L-Asp activity was measured by colorimetry on Day 7 and 14. MRD at EOI was assessed by flow cytometry. Statistical analysis included Fisher-exact, Chi-square, Mann-Whitney U, multivariable logistic regression and Kaplan-Meier survival analysis. Of the 60 patients enrolled, 56 were evaluable. Optimal serum L-Asp activity was achieved in 75% on Day 7 and 60.7% on Day 14. No significant association was observed between serum L-Asp activity status at Day 7 or 14 and MRD at EOI. However, the rate of decrement in L-Asp level between Day 7 and 14 was significantly associated with MRD status (P < 0.05). Although L-Asp status at Day 7 and 14 did not correlate with MRD at EOI, the trend in drug-level reduction between Day 7 and 14 was significantly associated with MRD status. Dynamic L-Asp monitoring may thus better predict MRD status at EOI in pediatric ALL.