Administration of GRASPA (Suspension of Erythrocytes Encapsulating L-asparaginase) in Elderly Patients With First Line Acute Lymphoblastic Leukemia

This open label, non randomised, multicentric and national phase IIa study was designed to evaluate the safety and efficacy of GRASPA®, a suspension of red blood cells encapsulating E. Coli L-asparaginase, at different doses and in combination with the polychemotherapy regimen recommended by the European Working Group on Adult ALL (EWALL) for frontline therapy of patients with ALL Ph-, aged 55 years old and over. Patients with a good performance status (WHO score ≤2) and a newly diagnosed ALL Ph- were treated with the backbone polychemotherapy consisting of a first 4-week induction phase comprising dexamethasone, vincristine and idarubicin, a second 4-week induction phase including cyclophosphamide, cytarabine, a 6-month consolidation phase consisting of 6 alternating cycles with methotrexate, asparaginase and folinic acid (cycles 1, 3 and 5) and high-dose cytarabine (cycles 2, 4 and 6) with Granulocyte colony stimulating factor (G-CSF) support followed by a 16-month maintenance period with mercaptopurine, methotrexate and vincristine/dexamethasone pulses. GRASPA® was administered on day 3 of induction 1 and on day 6 of induction 2 of the chemotherapy regimen.

Inclusion criteria

• Patient aged ≥55 years old
• With newly diagnosed ALL without prior treatment
• Capable to receive polychemotherapy (World Health Organization (WHO) performance status ≤2)
• With or without meningeal disease
• Having signed an Informed Consent Form
• Subscribed to social security insurance

Exclusion criteria

• ALL translocation(9;22) and/or BCR-ABL (Breakpoint Cluster Region-Abelson) positive
• Performance status incompatible with chemotherapy treatment (WHO score >2)
• Patient presenting with a general or visceral contraindication to intensive treatment including :

• Cardiac insufficiency defined as Left Ventricular Ejection Fraction <50% of the theoretical value
• Plasma creatinine concentration 2 times greater than the upper limit of laboratory ranges, except if related to ALL
• Aspartate aminotransferase (ASAT) or alanine aminotransferase (ALAT) levels 5 times greater than the upper limit of laboratory ranges, except if related to ALL
• Patient with another evolutive cancer other than ALL
• Severe evolutive infection, or Human Immunodeficiency Virus (HIV) seropositive or, active hepatitis related to B or C viral infection
• Prior treatment with L-asparaginase (irrespective of the form)
• History of grade 3 transfusional incident (life threatening)
• Patient presenting rare and/or dangerous anti-erythrocyte antibodies thus leading to the unavailability of phenotype compatible Red Blood Cells Concentrate
• Patient included in another clinical trial during the last 4 weeks