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Liposomal daunorubicin (Daunoxome) and polyethylated glycol conjugated asparaginase (PEG-ASPA) in children with relapsed and refractory acute lymphoblastic leukemia treated on compassionate basis.

Abstract

BACKGROUND
Daunoxome (DNX) is an encapsulated form of daunorubicin in liposomal vesicles with suggested better pharmacokinetics, pharmacodynamics and lesser cardio toxicity than the free form. Polyethyl glycol asparaginase (PEG-ASPA), a modified form of L-asparaginase, has better activity and lesser immunogenicity than its native molecule.
AIM
To evaluate on a compassionate basis, the combination of Daunoxome and PEG-ASPA, as regard to efficacy and toxicity, as a salvage treatment in refractory/relapsed childhood ALL.
METHODS
The combination of these 2 drugs were used in 9 multiple relapsed or refractory ALL children on the basis of: DNX weekly 100 mg/m2 D1, 8, 15. PEG-ASPA single, 2500IU/m2 dose D15. Vinca alkaloids and corticosteroids were associated.
RESULTS
Median hospital stay was 4 days (0-55). Complications: Neutropenia grade IV n=4, grade III infection n=6, grade II cardiac toxicity n=1, grade III allergy, grade III hemostasis disorders, thrombosis, n=1 respectively. All patients achieved complete remission (CR) except one who died from disease progression. 8 patients were subjected to hematopoietic stem cell transplantatation (HSCT). Two patients of them are alive and well, 4 died from transplant related causes and 2 from disease progression.
CONCLUSION
Salvage treatment containing DNX and PEG-ASPA, of small sample childhood ALL with very advanced disease, is feasible as regard toxicity and response rate allowing to HSCT and possible cure.

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  • Publisher Full Text

    • Authors

    Sedki M, Vannier JP, Leverger G, Yakouben K, Adjaoud D, Vilmer E, Baruchel A

    Institution

    The Department of Service d'Hématologie-Immunologie Pédiatrique, Hôpital Robert Debré, Paris, France. msedky64@yahoo.com

    Source

    Journal of the Egyptian National Cancer Institute 20:1 2008 Mar pg 55-62

    MeSH

    Adolescent
    Antineoplastic Combined Chemotherapy Protocols
    Asparaginase
    Child
    Compassionate Use Trials
    Doxorubicin
    Female
    Humans
    Male
    Polyethylene Glycols
    Precursor Cell Lymphoblastic Leukemia-Lymphoma
    Recurrence
    Retrospective Studies
    Salvage Therapy

    Pub Type(s)

    Journal Article

    Language

    eng

    PubMed ID

    19847282