Impact of Asparaginase Discontinuation on Outcome in Childhood Acute Lymphoblastic Leukemia: A Report From the Children's Oncology Group
Asparaginase (ASNase) is an important component of acute lymphoblastic leukemia (ALL) treatment, but is often discontinued because of toxicity. ASNase ( ) substitution was approved in 2011 for allergic reactions. has, however, been intermittently unavailable because of drug supply issues. The impact...
Uložené v:
| Vydané v: | Journal of clinical oncology Ročník 38; číslo 17; s. 1897 |
|---|---|
| Hlavní autori: | , , , , , , , , , , , , |
| Médium: | Journal Article |
| Jazyk: | English |
| Vydavateľské údaje: |
United States
10.06.2020
|
| Predmet: | |
| ISSN: | 1527-7755, 1527-7755 |
| On-line prístup: | Zistit podrobnosti o prístupe |
| Tagy: |
Pridať tag
Žiadne tagy, Buďte prvý, kto otaguje tento záznam!
|
| Abstract | Asparaginase (ASNase) is an important component of acute lymphoblastic leukemia (ALL) treatment, but is often discontinued because of toxicity.
ASNase (
) substitution was approved in 2011 for allergic reactions.
has, however, been intermittently unavailable because of drug supply issues. The impact of
substitution or complete ASNase discontinuation is unknown.
Patients aged 1-30.99 years in frontline Children's Oncology Group trials for B-cell acute lymphoblastic leukemia between 2004 and 2011 (National Cancer Institute [NCI] standard risk [SR]: AALL0331; NCI high risk: AALL0232) were included. The number of prescribed pegaspargase (PEG-ASNase) doses varied by trial and strata. Maintenance therapy did not contain ASNase. Landmark analyses at maintenance compared disease-free survival (DFS) among those receiving all prescribed PEG-ASNase doses versus switching to
but receiving all doses versus not receiving all ASNase doses.
We included 5,195 AALL0331 and 3,001 AALL0232 patients. The cumulative incidence of PEG-ASNase discontinuation was 12.2% ± 4.6% in AALL0331 and 25.4% ± 0.8% in AALL0232. In multivariable analyses, NCI high-risk patients not receiving all prescribed ASNase doses had inferior DFS (hazard ratio [HR], 1.5; 95% CI, 1.2 to 1.9;
= .002) compared with those receiving all prescribed PEG-ASNase doses. Patients with
substitution who completed subsequent courses were not at increased risk (HR, 1.1; 95% CI, 0.7 to 1.6;
= .69). NCI SR patients who discontinued ASNase were not at elevated risk (HR, 1.2; 95% CI, 0.9 to 1.6;
= .23), except when restricted to those with slow early response, who were prescribed more ASNase because of therapy intensification (HR, 1.7; 95% CI, 1.1 to 2.7;
= .03).
Discontinuation of ASNase doses is associated with inferior DFS in higher-risk patients. Our results illustrate the severe consequences of
shortages. |
|---|---|
| AbstractList | Asparaginase (ASNase) is an important component of acute lymphoblastic leukemia (ALL) treatment, but is often discontinued because of toxicity.
ASNase (
) substitution was approved in 2011 for allergic reactions.
has, however, been intermittently unavailable because of drug supply issues. The impact of
substitution or complete ASNase discontinuation is unknown.
Patients aged 1-30.99 years in frontline Children's Oncology Group trials for B-cell acute lymphoblastic leukemia between 2004 and 2011 (National Cancer Institute [NCI] standard risk [SR]: AALL0331; NCI high risk: AALL0232) were included. The number of prescribed pegaspargase (PEG-ASNase) doses varied by trial and strata. Maintenance therapy did not contain ASNase. Landmark analyses at maintenance compared disease-free survival (DFS) among those receiving all prescribed PEG-ASNase doses versus switching to
but receiving all doses versus not receiving all ASNase doses.
We included 5,195 AALL0331 and 3,001 AALL0232 patients. The cumulative incidence of PEG-ASNase discontinuation was 12.2% ± 4.6% in AALL0331 and 25.4% ± 0.8% in AALL0232. In multivariable analyses, NCI high-risk patients not receiving all prescribed ASNase doses had inferior DFS (hazard ratio [HR], 1.5; 95% CI, 1.2 to 1.9;
= .002) compared with those receiving all prescribed PEG-ASNase doses. Patients with
substitution who completed subsequent courses were not at increased risk (HR, 1.1; 95% CI, 0.7 to 1.6;
= .69). NCI SR patients who discontinued ASNase were not at elevated risk (HR, 1.2; 95% CI, 0.9 to 1.6;
= .23), except when restricted to those with slow early response, who were prescribed more ASNase because of therapy intensification (HR, 1.7; 95% CI, 1.1 to 2.7;
= .03).
Discontinuation of ASNase doses is associated with inferior DFS in higher-risk patients. Our results illustrate the severe consequences of
shortages. Asparaginase (ASNase) is an important component of acute lymphoblastic leukemia (ALL) treatment, but is often discontinued because of toxicity. Erwinia chrysanthemi ASNase (Erwinia) substitution was approved in 2011 for allergic reactions. Erwinia has, however, been intermittently unavailable because of drug supply issues. The impact of Erwinia substitution or complete ASNase discontinuation is unknown.PURPOSEAsparaginase (ASNase) is an important component of acute lymphoblastic leukemia (ALL) treatment, but is often discontinued because of toxicity. Erwinia chrysanthemi ASNase (Erwinia) substitution was approved in 2011 for allergic reactions. Erwinia has, however, been intermittently unavailable because of drug supply issues. The impact of Erwinia substitution or complete ASNase discontinuation is unknown.Patients aged 1-30.99 years in frontline Children's Oncology Group trials for B-cell acute lymphoblastic leukemia between 2004 and 2011 (National Cancer Institute [NCI] standard risk [SR]: AALL0331; NCI high risk: AALL0232) were included. The number of prescribed pegaspargase (PEG-ASNase) doses varied by trial and strata. Maintenance therapy did not contain ASNase. Landmark analyses at maintenance compared disease-free survival (DFS) among those receiving all prescribed PEG-ASNase doses versus switching to Erwinia but receiving all doses versus not receiving all ASNase doses.METHODSPatients aged 1-30.99 years in frontline Children's Oncology Group trials for B-cell acute lymphoblastic leukemia between 2004 and 2011 (National Cancer Institute [NCI] standard risk [SR]: AALL0331; NCI high risk: AALL0232) were included. The number of prescribed pegaspargase (PEG-ASNase) doses varied by trial and strata. Maintenance therapy did not contain ASNase. Landmark analyses at maintenance compared disease-free survival (DFS) among those receiving all prescribed PEG-ASNase doses versus switching to Erwinia but receiving all doses versus not receiving all ASNase doses.We included 5,195 AALL0331 and 3,001 AALL0232 patients. The cumulative incidence of PEG-ASNase discontinuation was 12.2% ± 4.6% in AALL0331 and 25.4% ± 0.8% in AALL0232. In multivariable analyses, NCI high-risk patients not receiving all prescribed ASNase doses had inferior DFS (hazard ratio [HR], 1.5; 95% CI, 1.2 to 1.9; P = .002) compared with those receiving all prescribed PEG-ASNase doses. Patients with Erwinia substitution who completed subsequent courses were not at increased risk (HR, 1.1; 95% CI, 0.7 to 1.6; P = .69). NCI SR patients who discontinued ASNase were not at elevated risk (HR, 1.2; 95% CI, 0.9 to 1.6; P = .23), except when restricted to those with slow early response, who were prescribed more ASNase because of therapy intensification (HR, 1.7; 95% CI, 1.1 to 2.7; P = .03).RESULTSWe included 5,195 AALL0331 and 3,001 AALL0232 patients. The cumulative incidence of PEG-ASNase discontinuation was 12.2% ± 4.6% in AALL0331 and 25.4% ± 0.8% in AALL0232. In multivariable analyses, NCI high-risk patients not receiving all prescribed ASNase doses had inferior DFS (hazard ratio [HR], 1.5; 95% CI, 1.2 to 1.9; P = .002) compared with those receiving all prescribed PEG-ASNase doses. Patients with Erwinia substitution who completed subsequent courses were not at increased risk (HR, 1.1; 95% CI, 0.7 to 1.6; P = .69). NCI SR patients who discontinued ASNase were not at elevated risk (HR, 1.2; 95% CI, 0.9 to 1.6; P = .23), except when restricted to those with slow early response, who were prescribed more ASNase because of therapy intensification (HR, 1.7; 95% CI, 1.1 to 2.7; P = .03).Discontinuation of ASNase doses is associated with inferior DFS in higher-risk patients. Our results illustrate the severe consequences of Erwinia shortages.CONCLUSIONDiscontinuation of ASNase doses is associated with inferior DFS in higher-risk patients. Our results illustrate the severe consequences of Erwinia shortages. |
| Author | Winick, Naomi J Devidas, Meenakshi Gupta, Sumit Salzer, Wanda L Raetz, Elizabeth A Mattano, Jr, Len A Schore, Reuven Maloney, Kelly W Loh, Mignon L Wang, Cindy Larsen, Eric C Hunger, Stephen P Carroll, William L |
| Author_xml | – sequence: 1 givenname: Sumit surname: Gupta fullname: Gupta, Sumit organization: Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada – sequence: 2 givenname: Cindy surname: Wang fullname: Wang, Cindy organization: Department of Biostatistics, University of Florida, Gainesville, FL – sequence: 3 givenname: Elizabeth A surname: Raetz fullname: Raetz, Elizabeth A organization: Primary Children's Hospital, Salt Lake City, UT – sequence: 4 givenname: Reuven surname: Schore fullname: Schore, Reuven organization: Children's National Medical Center, Washington, DC – sequence: 5 givenname: Wanda L surname: Salzer fullname: Salzer, Wanda L organization: US Army Medical Research and Materiel Command, Fort Detrick, MD – sequence: 6 givenname: Eric C surname: Larsen fullname: Larsen, Eric C organization: Department of Pediatrics, Maine Children's Cancer Program, Scarborough, ME – sequence: 7 givenname: Kelly W surname: Maloney fullname: Maloney, Kelly W organization: Children's Hospital Colorado, Aurora, CO – sequence: 8 givenname: Len A surname: Mattano, Jr fullname: Mattano, Jr, Len A organization: Harpoon Therapeutics Pharma Consulting, Mystic, CT – sequence: 9 givenname: William L surname: Carroll fullname: Carroll, William L organization: Department of Pediatrics and Perlmutter Cancer Center, New York University Langone Health, New York, NY – sequence: 10 givenname: Naomi J surname: Winick fullname: Winick, Naomi J organization: University of Texas Southwestern/Simmons Cancer Center, Dallas, TX – sequence: 11 givenname: Stephen P surname: Hunger fullname: Hunger, Stephen P organization: Department of Pediatrics and the Center for Childhood Cancer Research, Children's Hospital of Philadelphia, and the Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA – sequence: 12 givenname: Mignon L surname: Loh fullname: Loh, Mignon L organization: Department of Pediatrics, UCSF Benoiff Childen's Hospital and Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, CA – sequence: 13 givenname: Meenakshi surname: Devidas fullname: Devidas, Meenakshi organization: Department of Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, TN |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/32275469$$D View this record in MEDLINE/PubMed |
| BookMark | eNpNkMFPgzAUxhsz49z05tn0phdmKXSAN4JuzpCQGD2TUh6jSluk5bD_wD9bks3E5Eved_jey_t-CzTTRgNCNz5Z-ZSQh9esWPnJigSEhmfo0mc08qKIsdk_P0cLaz8J8cM4YBdoHlAasXCdXKKfneq5cNg0OLU9H_heam4BP0krjHZSj9xJo_GkYnTCKMBS46yVXd0aU-NUjA5wflB9a6qOWycFzmH8AiX5I07xG_RmcHgzGIVdC8fNAfSdxYUWpjP7A94OZuyv0HnDOwvXp7lEH5vn9-zFy4vtLktzT4SMOE9EjKwbMT3vCxLXIiIxo0ET1IwlnIqEM0L9RIgqoE1DYgKQgIg5gaoJeTQxWqL7491-MN8jWFeqqSp0HddgRlvSII5juvYJnaK3p-hYKajLfpCKD4fyjx79BXOLc_k |
| CitedBy_id | crossref_primary_10_3389_fphar_2024_1329220 crossref_primary_10_1080_10428194_2023_2171267 crossref_primary_10_1111_bcp_15550 crossref_primary_10_1016_j_clml_2021_07_009 crossref_primary_10_1055_s_0042_1742615 crossref_primary_10_1002_pbc_30716 crossref_primary_10_1016_j_ejca_2021_04_006 crossref_primary_10_1016_j_bcp_2020_114230 crossref_primary_10_1016_j_ejca_2021_08_025 crossref_primary_10_1007_s13205_023_03620_0 crossref_primary_10_1111_bjh_18373 crossref_primary_10_1002_cpdd_1002 crossref_primary_10_1002_pbc_29051 crossref_primary_10_1002_smtd_202500945 crossref_primary_10_3390_cancers16040723 crossref_primary_10_1007_s00277_025_06332_y crossref_primary_10_1080_10428194_2022_2102621 crossref_primary_10_1007_s11095_024_03693_3 crossref_primary_10_1016_j_beha_2023_101519 crossref_primary_10_1007_s13318_021_00741_w crossref_primary_10_1002_ajh_26193 crossref_primary_10_1182_bloodadvances_2022007791 crossref_primary_10_1182_bloodadvances_2024015455 crossref_primary_10_1200_GO_21_00388 crossref_primary_10_1002_pbc_29280 crossref_primary_10_2217_fon_2021_1288 crossref_primary_10_1002_pbc_29046 crossref_primary_10_3390_medsci10030043 crossref_primary_10_1016_j_jtct_2025_05_015 crossref_primary_10_1080_17512433_2023_2223970 crossref_primary_10_1002_pbc_29169 crossref_primary_10_1111_bjh_19605 crossref_primary_10_3390_ijms241311215 crossref_primary_10_1177_10781552211055405 crossref_primary_10_1080_0284186X_2023_2258450 crossref_primary_10_1182_bloodadvances_2024013346 crossref_primary_10_1002_cnr2_1533 crossref_primary_10_1080_10428194_2021_1961236 crossref_primary_10_1002_cncr_33568 crossref_primary_10_1016_j_blre_2021_100908 crossref_primary_10_1002_pbc_28743 crossref_primary_10_3390_ijms22168738 crossref_primary_10_1016_j_anai_2024_05_009 crossref_primary_10_3390_jcm10194419 crossref_primary_10_1111_bjh_17936 crossref_primary_10_1111_bjh_18745 crossref_primary_10_1002_pbc_30528 crossref_primary_10_1016_j_bulcan_2022_06_004 crossref_primary_10_1016_j_ymgme_2023_107627 crossref_primary_10_1016_j_biopha_2022_113000 crossref_primary_10_1182_bloodadvances_2025016160 crossref_primary_10_1038_s41417_024_00865_6 crossref_primary_10_1111_cts_13499 crossref_primary_10_1002_jcph_2052 crossref_primary_10_1111_bjh_17494 crossref_primary_10_1126_sciadv_adt3075 crossref_primary_10_1007_s12098_023_04731_5 crossref_primary_10_1002_pbc_30891 crossref_primary_10_1002_pbc_32030 crossref_primary_10_3389_fped_2022_828702 crossref_primary_10_1080_10428194_2022_2086251 crossref_primary_10_3389_fped_2022_902117 crossref_primary_10_1093_biomethods_bpae042 crossref_primary_10_1038_s41375_023_01992_z crossref_primary_10_1016_S2152_2650_22_00641_3 crossref_primary_10_1097_HS9_0000000000000893 crossref_primary_10_1038_s41375_024_02153_6 crossref_primary_10_1016_S1470_2045_21_00720_8 crossref_primary_10_1016_j_clml_2022_08_009 crossref_primary_10_1097_HS9_0000000000000888 crossref_primary_10_1182_bloodadvances_2021005631 crossref_primary_10_1016_S2152_2650_21_01224_6 crossref_primary_10_1093_ajhp_zxab152 crossref_primary_10_1016_j_tem_2021_03_003 crossref_primary_10_1016_S2152_2650_24_00349_5 crossref_primary_10_2147_BLCTT_S245210 crossref_primary_10_1016_j_canlet_2024_217404 crossref_primary_10_1097_MPH_0000000000003034 crossref_primary_10_1002_cam4_7246 crossref_primary_10_1038_s41390_021_01796_w crossref_primary_10_1177_10781552231164503 crossref_primary_10_1111_ejh_14189 crossref_primary_10_1111_cts_12947 crossref_primary_10_3389_fped_2022_855162 crossref_primary_10_1016_j_ejca_2021_11_016 crossref_primary_10_1097_MPG_0000000000003334 crossref_primary_10_1002_jha2_484 crossref_primary_10_3389_fonc_2024_1472049 crossref_primary_10_3389_fonc_2022_1094964 crossref_primary_10_1097_MPH_0000000000002396 crossref_primary_10_1111_bjh_18158 crossref_primary_10_1182_blood_2022018395 crossref_primary_10_1002_pbc_31668 crossref_primary_10_1055_s_0044_1788043 crossref_primary_10_1002_cnr2_1452 crossref_primary_10_1080_17512433_2025_2465426 crossref_primary_10_1111_bjh_18152 crossref_primary_10_1182_blood_2020006583 crossref_primary_10_1016_j_ejcped_2025_100225 crossref_primary_10_1016_j_bcp_2023_115630 crossref_primary_10_1016_j_ejcped_2025_100222 crossref_primary_10_1002_pbc_29875 crossref_primary_10_1200_GO_24_00444 crossref_primary_10_1016_j_cclet_2025_111222 crossref_primary_10_3390_cancers14040902 crossref_primary_10_1080_17425255_2023_2233412 crossref_primary_10_1186_s41182_025_00760_2 crossref_primary_10_1038_s41375_024_02287_7 crossref_primary_10_1007_s12185_024_03856_3 crossref_primary_10_1016_j_lansea_2025_100593 crossref_primary_10_3390_jpm11080715 crossref_primary_10_3390_children10071160 crossref_primary_10_1182_bloodadvances_2022009596 crossref_primary_10_1016_j_critrevonc_2024_104347 crossref_primary_10_1080_10428194_2022_2098288 crossref_primary_10_1007_s12185_024_03725_z crossref_primary_10_1038_s41375_023_02115_4 crossref_primary_10_1097_FTD_0000000000001252 crossref_primary_10_1111_ejh_14125 crossref_primary_10_1038_s41598_020_78549_y crossref_primary_10_1182_blood_2022016923 crossref_primary_10_1002_pbc_29865 crossref_primary_10_1080_10428194_2025_2543578 |
| ContentType | Journal Article |
| DBID | CGR CUY CVF ECM EIF NPM 7X8 |
| DOI | 10.1200/JCO.19.03024 |
| DatabaseName | Medline MEDLINE MEDLINE (Ovid) MEDLINE MEDLINE PubMed MEDLINE - Academic |
| DatabaseTitle | MEDLINE Medline Complete MEDLINE with Full Text PubMed MEDLINE (Ovid) MEDLINE - Academic |
| DatabaseTitleList | MEDLINE MEDLINE - Academic |
| Database_xml | – sequence: 1 dbid: NPM name: PubMed url: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed sourceTypes: Index Database – sequence: 2 dbid: 7X8 name: MEDLINE - Academic url: https://search.proquest.com/medline sourceTypes: Aggregation Database |
| DeliveryMethod | no_fulltext_linktorsrc |
| Discipline | Medicine Pharmacy, Therapeutics, & Pharmacology |
| EISSN | 1527-7755 |
| ExternalDocumentID | 32275469 |
| Genre | Journal Article Research Support, N.I.H., Extramural |
| GrantInformation_xml | – fundername: NCI NIH HHS grantid: U10 CA180899 – fundername: NCI NIH HHS grantid: U10 CA098413 – fundername: NCI NIH HHS grantid: U10 CA180886 – fundername: NCI NIH HHS grantid: UG1 CA233324 – fundername: NCI NIH HHS grantid: U10 CA098543 |
| GroupedDBID | --- .55 0R~ 18M 2WC 34G 39C 4.4 53G 5GY 5RE 8F7 AAQQT AARDX AAWTL AAYEP ABJNI ABOCM ACGFO ACGFS ACGUR ADBBV AEGXH AENEX AIAGR ALMA_UNASSIGNED_HOLDINGS AWKKM BAWUL BYPQX C45 CGR CS3 CUY CVF DIK EBS ECM EIF EJD F5P F9R FBNNL FD8 GX1 H13 HZ~ IH2 K-O KQ8 L7B LSO MJL N9A NPM O9- OK1 OVD OWW P2P QTD R1G RHI RLZ RUC SJN SV3 TEORI TR2 TWZ UDS VVN WH7 X7M YCJ YFH YQY 7X8 ABBLC |
| ID | FETCH-LOGICAL-c450t-c7506fc5461c08dc708523f3d559a2c9a50219ccb32ff080ee9ec8a0ebf4a7302 |
| IEDL.DBID | 7X8 |
| ISICitedReferencesCount | 147 |
| ISICitedReferencesURI | http://www.webofscience.com/api/gateway?GWVersion=2&SrcApp=Summon&SrcAuth=ProQuest&DestLinkType=CitingArticles&DestApp=WOS_CPL&KeyUT=000540597700004&url=https%3A%2F%2Fcvtisr.summon.serialssolutions.com%2F%23%21%2Fsearch%3Fho%3Df%26include.ft.matches%3Dt%26l%3Dnull%26q%3D |
| ISSN | 1527-7755 |
| IngestDate | Sun Nov 09 10:03:43 EST 2025 Thu Jan 02 22:58:13 EST 2025 |
| IsDoiOpenAccess | false |
| IsOpenAccess | true |
| IsPeerReviewed | true |
| IsScholarly | true |
| Issue | 17 |
| Language | English |
| LinkModel | DirectLink |
| MergedId | FETCHMERGED-LOGICAL-c450t-c7506fc5461c08dc708523f3d559a2c9a50219ccb32ff080ee9ec8a0ebf4a7302 |
| Notes | ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 |
| OpenAccessLink | https://www.ncbi.nlm.nih.gov/pmc/articles/7280050 |
| PMID | 32275469 |
| PQID | 2388826102 |
| PQPubID | 23479 |
| ParticipantIDs | proquest_miscellaneous_2388826102 pubmed_primary_32275469 |
| PublicationCentury | 2000 |
| PublicationDate | 2020-06-10 |
| PublicationDateYYYYMMDD | 2020-06-10 |
| PublicationDate_xml | – month: 06 year: 2020 text: 2020-06-10 day: 10 |
| PublicationDecade | 2020 |
| PublicationPlace | United States |
| PublicationPlace_xml | – name: United States |
| PublicationTitle | Journal of clinical oncology |
| PublicationTitleAlternate | J Clin Oncol |
| PublicationYear | 2020 |
| SSID | ssj0014835 |
| Score | 2.6406715 |
| Snippet | Asparaginase (ASNase) is an important component of acute lymphoblastic leukemia (ALL) treatment, but is often discontinued because of toxicity.
ASNase (
)... Asparaginase (ASNase) is an important component of acute lymphoblastic leukemia (ALL) treatment, but is often discontinued because of toxicity. Erwinia... |
| SourceID | proquest pubmed |
| SourceType | Aggregation Database Index Database |
| StartPage | 1897 |
| SubjectTerms | Adolescent Asparaginase - administration & dosage Asparaginase - adverse effects Asparaginase - supply & distribution Child Child, Preschool Disease-Free Survival Erwinia - enzymology Female Humans Infant Male Polyethylene Glycols - administration & dosage Polyethylene Glycols - adverse effects Polyethylene Glycols - supply & distribution Precursor Cell Lymphoblastic Leukemia-Lymphoma - drug therapy Prognosis Randomized Controlled Trials as Topic Substance Withdrawal Syndrome - etiology Treatment Outcome |
| Title | Impact of Asparaginase Discontinuation on Outcome in Childhood Acute Lymphoblastic Leukemia: A Report From the Children's Oncology Group |
| URI | https://www.ncbi.nlm.nih.gov/pubmed/32275469 https://www.proquest.com/docview/2388826102 |
| Volume | 38 |
| WOSCitedRecordID | wos000540597700004&url=https%3A%2F%2Fcvtisr.summon.serialssolutions.com%2F%23%21%2Fsearch%3Fho%3Df%26include.ft.matches%3Dt%26l%3Dnull%26q%3D |
| hasFullText | |
| inHoldings | 1 |
| isFullTextHit | |
| isPrint | |
| link | http://cvtisr.summon.serialssolutions.com/2.0.0/link/0/eLvHCXMwpV1Na9wwEBXNB6GXtE3SJv0IUwjJJU5sS17bvZQl7ZKWZHcPCextkUcjMCV2st4t7D_oz-7IcrKnQKFgfBMamNHoaUZ6T4ijJLUpYqQDilURqDTUgY56vPBUbE2BUmrjxSbS4TCbTPJxV3BrumuVjzmxTdSmRlcjP-ethcEgb_bx1_uHwKlGue5qJ6GxJjYkQxkX1elk1UVQWSuw6ZRbGUUmSXfxnQPj_OfF6Cxy_Kahe-v-HLhsN5nBq_8177XY7uAl9H08vBEvqNoRW9ddA31HHI89VfXyFG5WL6-aUziG8YrEerkr_vxon09CbaHfOH5wp9_QEHwrG3e7vaw8RTjwN1rM2UaCsoInomTo42JOcLXkYKkLRug8C1zR4hfdlfoL9MEDfxjM6jtgDOpHzqg6aWBUeSOgrYvtidvB95uLy6BTbQhQJeE8QMYgPYuJ6kUYZgZTBnWxtNLw2UXHmOuEYUWOWMjYWsarRDlhpkMqrNKcb-K3Yr2qK9oXgGFkpCXKpCaVFVGhTWhIMqRTyqCSB-LzozOmvCpcq0NXVC-a6codB-Kd9-j03tN3TDmFpWxd_v4fRn8QL2N3wHZiReFHsWE5J9AnsYm_52UzO2zDjf_D8fVfga7h7g |
| linkProvider | ProQuest |
| openUrl | ctx_ver=Z39.88-2004&ctx_enc=info%3Aofi%2Fenc%3AUTF-8&rfr_id=info%3Asid%2Fsummon.serialssolutions.com&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.atitle=Impact+of+Asparaginase+Discontinuation+on+Outcome+in+Childhood+Acute+Lymphoblastic+Leukemia%3A+A+Report+From+the+Children%27s+Oncology+Group&rft.jtitle=Journal+of+clinical+oncology&rft.au=Gupta%2C+Sumit&rft.au=Wang%2C+Cindy&rft.au=Raetz%2C+Elizabeth+A&rft.au=Schore%2C+Reuven&rft.date=2020-06-10&rft.eissn=1527-7755&rft.volume=38&rft.issue=17&rft.spage=1897&rft_id=info:doi/10.1200%2FJCO.19.03024&rft_id=info%3Apmid%2F32275469&rft_id=info%3Apmid%2F32275469&rft.externalDocID=32275469 |
| thumbnail_l | http://covers-cdn.summon.serialssolutions.com/index.aspx?isbn=/lc.gif&issn=1527-7755&client=summon |
| thumbnail_m | http://covers-cdn.summon.serialssolutions.com/index.aspx?isbn=/mc.gif&issn=1527-7755&client=summon |
| thumbnail_s | http://covers-cdn.summon.serialssolutions.com/index.aspx?isbn=/sc.gif&issn=1527-7755&client=summon |