Impact of asparaginase discontinuation on outcomes in ND ALL: A Chinese retrospective study

A retrospective cohort study investigated the impact of asparaginase discontinuation on outcomes in Chinese pediatric patients with newly diagnosed B-cell acute lymphoblastic leukemia (B-ALL) or T-cell ALL (n = 993). Patients were treated with Chinese Children’s Cancer Group ALL-2015 (CCCG-ALL-2015) protocol and were grouped into the truncated (n = 40) and the nontruncated cohort (n = 953). Outcomes included cumulative incidence of relapse (CIR), overall survival (OS), and event-free survival (EFS). Results were published by Wang et al. in the Annals of Hematology.

Key data: In the truncated vs nontruncated cohort, the 6-year CIR was 27.5% vs 14.0% (hazard ratio [HR], 2.24; p = 0.01), EFS was lower (HR, 2.11; p = 0.015), while OS showed a borderline decrease (HR, 2.74; 95% CI, 0.97–7.71; p = 0.046). In the intermediate-risk group, CIR was higher (31.3% vs 17.6%; p = 0.04) and EFS was lower (HR, 1.95; p = 0.046) in the truncated vs nontruncated cohort. CIR was higher in the <53% vs >53% of planned asparaginase doses group (32.1% vs 14.0%; HR, 2.71; p = 0.004). Older age (≥10 years), higher measurable residual disease (MRD) (Day 19 ≥0.1%) levels, and asparaginase exposure percentage were predictors of discontinuation.

Key learning: These findings suggest that asparaginase discontinuation was associated with inferior outcomes in pediatric patients with ALL, particularly those with intermediate risk. The study highlights the importance of individualized treatment strategies and maintaining treatment intensity through alternative formulations in this population.