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CC BY-NC-ND 4.0 · South Asian J Cancer
DOI: 10.1055/s-0043-1767811
Original Article

Practice of L-Asparaginase Usage: A Survey among Healthcare Providers Treating Children with Cancer in India

Archana MV
1   Division of Pediatric Hematology and Oncology, Manipal Comprehensive Cancer Care Centre, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India.
,
Kalasekhar VS 
2   Department of Pediatric Oncology, Regional Cancer Centre, Trivandrum, Kerala, India
,
Vinay Munikoty
1   Division of Pediatric Hematology and Oncology, Manipal Comprehensive Cancer Care Centre, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India.
,
Ramitha R. Bhat
1   Division of Pediatric Hematology and Oncology, Manipal Comprehensive Cancer Care Centre, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India.
,
Atul Achyutrao
1   Division of Pediatric Hematology and Oncology, Manipal Comprehensive Cancer Care Centre, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India.
,
Vani Lakshmi R
3   Department of Data Science, Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, Karnataka, India
,
Vasudeva Bhat K 
1   Division of Pediatric Hematology and Oncology, Manipal Comprehensive Cancer Care Centre, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India.
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Abstract

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Vasudeva Bhat K

Introduction L-asparaginase is an essential chemotherapeutic agent in the therapy of acute lymphoblastic leukemia (ALL), which has led to improvement in survival. In low- and middle-income countries like India, the outcomes in ALL are inferior compared with the published literature, one of the causes of which is believed to be due to the inferior quality of bioequivalent asparaginase.

Objective The following survey attempts to understand the practice of using this agent among oncologists treating children with cancer in our country.

Methods The researchers designed a structured online questionnaire comprising 25 aspects of L-asparaginase usage in the study. The questionnaire was directed to the healthcare providers involved in treating children with cancer in India.

Results Of the total 80 responses recorded, 51 (64%) respondents had more than 5 years of experience in pediatric oncology and were treating at least 5 to 10 newly diagnosed ALL patients per month. Forty-one (51%) respondents utilized native asparaginase, and 21 (26.3%) oncologists used PEGylated-asparaginase exclusively. The most common route of administration was the intramuscular route (66.3%). Seventy percent of respondents utilized native form at a dose of 10,000 IU/m2 and 20% at 6,000 IU/m2. The amounts used for PEGylated L-asparaginase were 1,000,IU/m2, 2,500,IU/m2, and variable doses in 48, 40, and 10% of responses, respectively. Though serum asparaginase assay (SAA) was not measured routinely in most of the centers, 39 (48.8%) healthcare providers perceived performing SAA helps to make the clinical decision.

Conclusion This survey shows a wide variation in L-asparaginase usage among healthcare providers caring for children with cancer in our country. As L-asparaginase is the pivotal component of ALL therapy, uniformity in its usage and dosing with the possibility of monitoring SAA due to the quality of bioequivalent may be one of the critical steps toward improving outcomes in ALL in our country.

Keywords

asparaginase - oncologists - pediatric ALL

Note

Presented as a poster in 53rd Congress of the International Society of Pediatric oncology (SIOP), virtual congress, October 21 to 24, 2021


Authors' Contributions

Archana MV designed the study design, collected data, and written manuscript. Vasudeva Bhat conceptualized the research, prepared the study design, and approved the final version of the manuscript. Kalashekar VS and Vinay Munikoty reviewed and approved the final version of the manuscript. Vanilakshmi analyzed the data. Ramitha and Atul helped with data collection and edited manuscript.


All authors have contributed to the manuscript in significant ways and have reviewed and agreed upon the manuscript content.


Review Board Approval

The Institutional Ethics Committee (IEC), Kasturba Hospital and Kasturba Medical College, Manipal (IEC 532/2020) approved the study protocol.




Publication History

Article published online:
10 April 2023

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