Case report of silent inactivation of Asparaginase in acute lymphoblastic leukemia with late bone marrow relapse
10.3760/cma.j.cn101070-20200225-00252
- VernacularTitle:急性淋巴细胞白血病晚期骨髓复发并门冬酰胺酶静默失活1例
- Author:
Yu LI
1
;
Minyi YE
;
Xiaoli ZHANG
;
Xuequn LUO
;
Libin HUANG
Author Information
1. 中山大学附属第一医院儿科，广州 510080
- Keywords:
Acute lymphoblastic leukemia;
Asparaginase;
Silent inactivation;
Treatment
- From:
Chinese Journal of Applied Clinical Pediatrics
2021;36(17):1351-1353
- CountryChina
- Language:Chinese
-
Abstract:
Retrospective analysis was performed on 1 child with silent inactivation (SI) of asparaginase (ASNas) who was diagnosed with acute lymphoblastic leukemia (ALL) and treated in the First Affiliated Hospital, Sun Yat-Sen University in October 2019.The patient was a 9 years and 3 months old boy who was diagnosed as ALL accompanied with late bone marrow relapse.After pegylated Escherichia coli-Asparaginase (PEG-ASNase) was given, he did not have the expected treatment-related adverse reactions, including hyperammonemia, hypofibrinogenemia, and the low activation of antithrombin Ⅲ (ATⅢ). The plasma asparagine (ASN) concentration failed to meet the depletion criteria and the ASNase activity was 64.5 U/L.Therefore, the SI of ASNase was confirmed.Erwinase was used to replace PEG-ASNase, the lowest level of ATⅢ was 33%, and the lowest level of fibrinogen was 1.20 g/L.Hyperammonemia and decreased ASN were also observed, and the ASNase activity was 1 813.0 U/L.All the above suggested that when, SI occurred, the replacement by Erwinase was effective.The ASNase activity should be monitored in ALL patients who were treated with ASNase.Monitoring the treatment-related adverse reactions such as hyperammonia and coagulation disorders closely has important implications to the SI of ASNase when the detection of ASNase activity was unavailable.
