B. De Moerloose MD, PhD

PEG-asparaginase in the treatment of childhood acute lymphoblastic leukaemia

Summary

Asparaginase is an essential compound of combination chemotherapy in acute lymphoblastic leukaemia in children and adults. Essentially, three preparations of asparaginase are used in childhood acute lymphoblastic leukaemia: native Escherichia coli asparaginase, Erwinia chrysanthemi asparaginase and PEG-asparaginase. Although PEG-asparaginase seems to have some advantages over the other asparaginase preparations, its clinical use in Europe is limited to second-line therapy after allergic reactions to native asparaginase. This is in contrast to the United States, where PEG-asparaginase has been approved as first-line treatment of children with acute lymphoblastic leukaemia. This report describes the properties, clinical benefits and side effects of PEG-asparaginase.

(BELG J HEMATOL 2013;4(4): 138–143)

Cost-minimisation analysis of PEG-L-Asparaginase versus native L-Asparaginase for the treatment of children with acute lymphoblastic leukaemia in Belgium

Summary

PEG-L-Asparaginase (Oncaspar®) is a major compound of antineoplastic combination therapy for reinduction in acute lymphoblastic leukaemia in children and adults with known hypersensitivity. In the United States, it has been approved for many years as first-line treatment of children with acute lymphoblastic leukaemia. Its clinical benefits have been extensively described. In this report, a cost-minimisation analysis comparing the direct cost of PEG-L-asparaginase with that of native E. coli and Erwinia L-asparaginase treatment is described.

(BELG J HEMATOL 2013; 4(4): 144–147)

P.31 Study of the miRNome of childhood myelodysplastic syndrome

Musculoskeletal manifestations in children with acute lymphoblastic leukaemia

Summary

Acute lymphoblastic leukaemia (ALL) is the most common kind of childhood malignancy. Although the vast majority of patients are presented with medullary signs and symptoms such as an abnormal blood count, about one third will initially be presented with musculo-skeletal complaints (with or without radiological abnormalities) as the only apparent abnormality. These skeletal manifestations in ALL are not pathognomonic and may mimic several orthopaedic conditions, such as juvenile rheumatoid arthritis, osteomyelitis, septic arthritis and transient synovitis. This may therefore contribute to a delay in diagnosis, resulting in higher morbidity and mortality rates. However, musculoskeletal manifestations in leukaemia are usually associated with a precursor-B-ALL and have a good prognosis.

The purpose of this review is to highlight the diagnostic pitfalls in this type of ALL. ALL should always be considered as a differential diagnosis in any child with unexplained or persistent bone pain and a bone marrow examination is highly recommended when steroid therapy is being considered.

(BELG J HEMATOL 2012;3:3–11)