Abstract
Our study represents the first description of PAP, a novel early marker for AAP risk prediction, in pediatric patients with ALL and AAP, detection of which could potentially lead to individual patient therapy tailoring. By identifying patients susceptible to AAP and avoiding its severe manifestations, L-asparaginase truncation could be eschewed, which could eventually result in an improvement of patients' overall outcome.
We propose that patients with elevated PAP levels should be closely monitored for possible AAP development. Frequent measurements of PAP and AAP diagnostic markers should be exploited, predominantly in treatment protocols with serial L-asparaginase administrations, together with the early use of imaging methods when clinical symptoms appear.
Last but not least, we believe that the presented data will stimulate additional larger studies addressing this important question.