Absence of NOTCH1 gene mutations in MALT lymphomas

pancreatitis. We hesitate to perform re-challenges with l-asparaginase in order to avoid life-threatening pancreatitis. However, l-asparaginase remains the most useful drug for ALL, and re-treatment with the drug after recovery from acute pancreatitis is expected. Among the 19 patients receiving native Escherichia coli l-asparaginase in protocol MCP-841 who developed pancreatitis between 1986 and 1996, 11 subsequently received another preparation, Erwinia l-asparaginase, and these patients had no recurrence of the pancreatitis (Sahu et al, 1998). Erwinia chrysanthemi l-asparaginase is licensed in the UK but has not been approved for commercial use in other countries, including Japan. Although the mechanisms for the development of acute pancreatitis remain unclear, the destruction of the organ by digestive enzymes may be related to disease progression. The inhibition of pancreatic activity, which reduces exocrine secretion and further prevents the release and activation of enzymes, was therefore suggested as a specific treatment concept (Uhl et al, 1999). Octreotide, which is a synthetic somatostatin analogue consisting of eight amino acids, is a potent inhibitor of both basal and stimulated exocrine pancreatic secretion. Further advantages of octreotide in comparison with the native hormone, somatostatin, include an increased half-life, higher potency, and subcutaneous application (Uhl et al, 1999). Although somatostatin and octreotide were expected to improve non-drug-induced pancreatitis, large clinical trials have demonstrated that both drugs had no effect on the course of the disease (Bang et al, 2008). However, several studies have indicated that somatostatin or octreotide may be useful as prophylaxis against postendoscopic retrograde cholangiopancreatography pancreatitis (Bang et al, 2008). Suzuki et al (2008) reported that prophylactic octreotide was useful in the re-treatment of l-asparaginase in a patient who had developed l-asparaginase-associated pancreatitis. Our results suggest that octreotide is useful for preventing pancreatitis in re-treatment with l-asparaginase. However, more data are needed to verify the usefulness of prophylactic octreotide therapy.