Efficacy And Adverse Reaction Comparison Of Pegaspargase And L-asparaginase In Treating Childhood Acute Lymphoblastic Leukemia

Objective: To compare the efficacy and adverse reaction ofpegaspargase(PEG-Asp) and L-asparaginase (L-Asp) intensive treatment of childrenwith acute lymphoblastic leukemia(ALL),in order to provide reference for the choiceof chemotherapy regine for children with ALL,and put forward appropriate tactics forits kinds of security problems,to guide the clinical drug selection and treatment.Methods：The clinical data of65children with ALL who received intensivetreatment with PEG-Asp (PEG-Asp group) and L-Asp (L-Asp group) at Departmentof Shanxi Province Children,s Hospital Department of Hematology from January2009to January2012were collected and analysed.The PEG-ASP group comprised25cases,13boys and12girls,with median age of5.86years, the group of standard riskhave6cases,the group of middle risk have15cases, and the group of high risk have4cases;the L-Asp group comprised40cases,35boys and15girls,with median age of7.05yeaes, the group of standard risk have9cases,the group of middle risk have26cases, and the group of high risk have5cases.The children in both groups receivedintensive treatment with vincristine,daunorubicin and dexamethasone.In addition,thePEG-Asp group was given IM pegaspargase2500U/m2once every one to two weeksfor two times, and the L-Asp group was given an IV of L-Asp5000-10000U/m2onceevery other day for six to eight times. Two groups of patients were strictly enforcedthe low-fat、low-sugar、low-protein balance diet before and after chemotherapy,and laboratory test,including routine blood,coagulation function,blood glucose,bloodlipid,serum amylase,urinary amylase and liver、 kidney function,myocardialenzymes and so on, were performed regulaly, observed the bone marrow remissionand long-term efficiency,recorded the time of hospitalization、compare the expense ofhospitalization,observed the kinds of adverse reaction in therapy.Result：1.Compare the efficiency indicators of two groups1.1Compare the rate of bone marrow remission:reexamine routine bone marrowbefore and after chemotherapy,23cases in PEG-Asp group was complete remission(CR),remission rate was92%,36cases in L-Asp group was complete remission(CR),remission rate was90%, the difference in the duration of complete remissionbetween the two groups was not statistically significant.(P＞0.05).1.2Compare the long-term efficiency: The difference of the progression-free survivalrate between the PEG-Asp group (80%) and the L-Asp group (75%) was notstatistically significant.(P＞0.05).2.Compare the time of hospitalization:The difference of hospitalization between thePEG-Asp group [(8.80±3.96)day] and the L-Asp group [(14.57±2.64)day] wasstatistically significant.(P＜0.05).3. Compare the expenses of hospitalization:The difference of average expenses ofhospitalization between the PEG-Asp group [(5725.40±74.30)yuan] and the L-Aspgroup [(2607.50±77.30)yuan] was statistically significant.(P＜0.05).4. Compare the adverse reaction4.1Allergic reactions: During chemotherapy,the allergic reaction in the two groups ofchildren were12.5%and4%,allergic reaction of L-Asp was significantly higher thanthat in PEG-Asp group,the difference was statistically significant.(P＜0.05).4.2The bone marrow suppression:①The level of the bone marrow suppression: During chemotherapy of VDLD treatment,different degree of bone marrowsuppression appeared in the two groups,and there was no statistically significantdifference between them.(P＞0.05).②The time of the bone marrow suppression:The difference in the duration of bone marrow supression between the PEG-Aspgroup [(26.8±1.92)day]and the L-Asp group [(17.0±2.23)day] was statisticallysignificant.(P＜0.05).4.3The coagulation disorder:During chemotherapy,abnormal blood coagulationsuch as APTT(activated partial thromboplastin time) increase, FIB(fibrinogen)reduce, PT(prothrombin time) increase, in which PT increase significantly,and therewas no statistically significant difference between the two grade of coagulationdisorder.(P＞0.05).4.4Biochemistry indexes disorder: During chemotherapy,the difference ofoccurence rates of varied signs including transaminase,bilirubin,high cholesterol andblood glucose level and low serum albumin between the PEG-Asp group (12.5%、5.0%、7.0%、2.5%、10.0%) and the L-Asp group (12.0%、4.0%、4.0%、0%、4.0%) was not statistically significant.(P＞0.05).4.5The symptoms of digestive system:During chemotherapy,the difference of thetwo groups occured the vomit、nausea、abdominal pain、diarrhoea between the thePEG-Asp group (4、0、0) and the L-Asp group (7、1、2) was not statisticallysignificant.(P＞0.05).Conclusion:1.PEG-Asp and L-Asp can achieve higher bone marrow remission rate in theintensive treatment of children with ALL, Explained they are significant effect andthey can improve the further survival rate in children with ALL;2.The duration of hospitallization are shorted and the hospitallization cost arededuced obviously in the PEG-ASP than L-ASP; 3.During chemotherapy,the two groups could occured the allergic reaction、coagulation disorder、biochemistry indexes disorder(the reduction of fibrinogen,theprolonger of and activeated-partial-thromboplastin-time and prothrombin)in differentdegree， Biochemistry indexes disorder during chemotherapy (includingtransaminase,bilirubin,high cholesterol and blood glucose level and low serumalbumin), The symptoms of digestive system(example the vomit、nausea、abdominalpain、diarrhoea).Their pattern and grade of adverse reaction are similar,butPEG-ASP has the features of lower and single adverse reaction;4.During chemotherapy,both of the two groups were occured bone marrowsuppression, the children of PEG-Asp longer than the L-Asp in the time of bonemarrow suppression,so the rate of infection also higher relatively, routine bloodneeded to performed before、middle and after chemotherapy,prevent and control theinfection;5.The PEG-ASP has the advantages of lower frequency of administration、lessallergic reaction、shorter duration of average hospitallization、save the expense ofhospitallization, not only applied to recur cases or allergiced to L-Asp,but alsorecommend to the therapy to the first occured ALL,it has some extend significant inclinical.