Asparaginase is integral to pediatric-inspired regimens to treat acute lymphoblastic leukemia (ALL) in adolescents and young adults (AYA). Global availability of 4 different asparaginase formulations creates the need to understand clinical and pharmacokinetics differences between the products to optimize patient care. Asparaginase-associated toxicities often preclude delivery of planned therapy. Older age, obesity and/or large body surface area (BSA) have been associated with higher risk of asparaginase toxicities, but data are conflicting, and the impact of dose modification based on these factors is unknown. Cessation of pegaspargase during pediatric B-cell ALL therapy is associated with increased risk of relapse and death, especially in high risk patients. Allergic/hypersensitivity reactions are often the main reason for discontinuation of pegaspargase and availability of Erwinia formulations has been unpredictable over the past several years. Premedications and asparaginase activity monitoring has the potential to decrease the incidence of hypersensitivity reactions and therapy changes, however, the data to support routine use of pegaspargase premedications is conflicting.
Learning Objectives:
Describe available asparaginase formulations
Highlight differences between formulations: pharmacokinetics, dosing/administration, shelf-life