Unlike healthful cells, leukemia cells cannot make their own way to obtain asparagine, an important amino acid nutrient, and so are dependent on obtaining asparagine from a leukemia affected individual's bloodstream serum. In administering the L-asparaginase enzyme to patients, serum levels of asparagine are depleted, leaving the leukemia cells without asparagine, which outcomes in leukemic cell death. Unfortunately, many individuals treated with L-asparaginase type antibodies to the enzyme, and do not experience any clinical indications of hypersensitivity. However these antibodies can either inactivate the enzyme or improve the metabolism of asparaginase such that the patient may not have adequate serum or plasma activity amounts to achieve an anti-leukemic impact.A complete of 921 sufferers underwent randomization and 32 withdrew or were withdrawn by the investigators after randomization , leaving 444 sufferers in the restrictive-strategy group and 445 in the liberal-technique group for the intention-to-treat evaluation. The baseline characteristics were similar in the two groups . A complete of 277 patients experienced cirrhosis, and the baseline features of the sufferers in this subgroup were similar in the two transfusion-strategy groups .