Asparaginase is an enzyme made from the bacteria escherichia coli (E. coli). In this country, two forms of asparaginase are available: one made from E. coli, and a slightly changed version of the E.Coli form linked to polyethylene glycol (PEG) molecule. This PEG-linked asparaginase is called pegaspargase. This version was made available in 1994, is more expensive than the other form, and is mainly used in patients who have developed an allergy to E. Coli. Another natural form of asparaginase made from the plant bacteria erwinia carotovora is known by the brand name Erwinar and can be specially obtained for patients who develop a severe allergy to E. coli asparaginase. Asparaginase kills cancer cells by depleting a certain protein in the blood (L-asparagine) that is necessary for survival and growth of tumor cells in patients with ALL. Fortunately, normal cells are not dependent on L-asparagine for survival.
Adults and children
INDUCTION CHEMOTHERAPY FOR ALL.
Doses vary between different chemotherapy protocols. The usual dose is 6, 000-10, 000 units per square meter of body surface area given for 10 days. Patients should refer to individual protocol for recommended dose.
This medicine can be given directly into the muscle (intramuscular) or into the vein (intravenous). Intramuscular injection of asparaginase lowers the risk of severe allergic reactions (also known as hypersensitivity or anaphylaxis). The risk of hypersensitivity reaction is higher with the second and third dose of the drug.
The use of this medication should be avoided in patients with active pancreatitis (inflammation of the pancreas) or history of pancreatitis, and in patients with serious allergic reaction to asparaginase in the past.
Asparaginase should only be given in a hospital. A patient's blood pressure will need to be monitored every 15 minutes for the first hour. A small test dose may be given to check if patient is allergic to this medicine.
This medication can lower the body's ability to fight infections. Patients should avoid contact with crowds or any individual that may have an infection.
Breast-feeding mothers should use asparaginase with caution. It is not yet known whether this drug crosses into breast milk. Women who are pregnant or may become pregnant should avoid this drug unless the benefits to the mother outweigh the risks to the child.
Contact a doctor immediately if any of these symptoms develop:
- fever, chills, sore throat
- yellowing of the skin or eyes
- puffy face, skin rash, trouble breathing, joint pain
- drowsiness, confusion, hallucinations, convulsions
- unusual bleeding or bruising
- stomach pain with nausea, vomiting and loss of appetite
A physician will perform blood tests before starting therapy and during therapy to monitor complete blood count, blood sugar, and pancreas, kidney, and liver functions.
Asparaginase is a very potent medicine that can cause serious side effects. An allergic reaction with skin rash, itching, joint pain, puffy face, and difficulty breathing can occur very quickly after injection with his drug. This side effect is managed by having the drugs epinephrine, diphenhydramine, and steroids available near the bedside to counter the allergic reaction if it occurs. Other common side effects include nausea, vomiting, diarrhea, loss of appetite, stomach cramps, and yellowing of the eyes or skin. Less frequent side effects include high blood sugar, drowsiness, confusion, hallucinations, convulsions, decreased kidney function, increased blood clotting, mouth sores, and decreased ability to fight infections. Usually the side effects of asparaginase are more severe in adults than in children.
Asparaginase can decrease breakdown and increase toxicity of cyclophosphamide.
This medicine can increase blood sugar especially when given in together with steroids.
Asparaginase should be given after vincristine instead of before or with vincristine because it can increase the risk of numbing, tingling and pain in hands and feet.
Olga Bessmertny, Pharm.D.
Acute lymphocytic leukemia (ALL)
—This is the most common cancer in children. Patients with ALL can present with fever, weakness, fatigue, pallor, unusual bleeding and easy bruising, pinpoint dots on the skin, large lymph nodes, large liver and spleen. ALL in children has a much better prognosis than in adults, with over 90% of children going into remission and an 80% cure rate with chemotherapy.
—An immediate kind of an allergic reaction that usually happens after a second exposure of a body to a drug, toxin, or some types of foods. A person may experience a dangerous drop in blood pressure, skin rash, itching, puffiness of the face, and difficulty breathing. Anaphylaxis is a medical emergency and can result in death.
—The first stage in treatment of ALL. The purpose of this stage is to quickly cause remission of the disease. The combination of vincristine, asparaginase, and steroids make up the foundation of induction regimen.