L-asparaginase e perspectivas no tratamento da leucemia linfoblástica aguda: revisão de literatura

Abstract

Introduction: L-Asparaginase is being studied as an alternative in the treatment of Acute Lymphoblastic Leukemia (ALL). This enzyme has the ability to induce apoptosis in leukemic cells, since they are not capable of synthesizing asparagine, unlike normal cells that produce it. Studies have shown beneficial actions in the treatment of ALL, but it can develop adverse effects such as nausea, fever, hypersensitivity reactions, liver, pancreatic and neurological disorders. Objective: This work aims to present and explain the history of L-Asparaginase, advantages, disadvantages, challenges faced by Brazil, in addition to the mechanisms of action involving the forms of the enzyme, and adverse effects of its use. Methods: Articles in Portuguese and English were included in this work, consulted in article banks such as PubMed and SciELO, covering the period from 1953 to the present day in 2021. Results: L-Asparaginase is an enzyme that breaks down Asparagine into Aspartate and Ammonia, it was isolated from colonies of Escherichia coli and Erwinia chrysanthemi. In addition, the enzyme was polymerized with polyethylene glycol for therapeutic purposes in patients with ALL. The use of corticosteroids, antihistamines and vitamin supplementation proved to be effective in mitigating adverse effects. Conclusions: Thus, studies are needed to avoid a shortage of L-Asparaginase in Brazil. The main reason for this crisis would be the difficulty of marketing, and high costs, despite being a drug on the WHO list as essential, the country is in difficulties, as research universities are evaluating new treatment possibilities with L-Asparaginase that are more viable in terms of cost and adverse effects.