Asparaginase-associated toxicity in children with acute lymphoblastic leukemia
Nobuko Hijiya1, Inge M van der Sluis2
1a Division of Hematology/Oncology/Stem Cell Transplant, Ann & Robert H. Lurie Children's Hospital of Chicago and Department of Pediatrics, Feinberg School of Medicine , Northwestern University , Chicago , IL , USA ;
Insights
Asparaginase is crucial for treating childhood acute lymphoblastic leukemia, but toxicities like hypersensitivity can interrupt therapy. Managing these side effects ensures patients complete treatment for better outcomes.
Area of Science:
- Pediatric Oncology
- Pharmacology
- Hematology
Background:
- Asparaginase is a key drug in treating acute lymphoblastic leukemia (ALL) in children.
- Completing the full course of asparaginase therapy is linked to positive patient outcomes.
- Asparaginase use is associated with several toxicities, including hypersensitivity, pancreatitis, thrombosis, encephalopathy, and liver dysfunction.
Purpose of the Study:
- To review common toxicities associated with asparaginase therapy.
- To provide recommendations for managing asparaginase-induced toxicities.
- To emphasize the importance of managing toxicities for treatment completion and maximizing therapeutic benefit.
Main Methods:
- Literature review of asparaginase-associated toxicities.
- Analysis of clinical data regarding toxicity incidence and management.
- Synthesis of current recommendations for toxicity management.
Main Results:
- Clinical hypersensitivity is the most frequent toxicity, necessitating treatment discontinuation in up to 30% of patients receiving E. coli-derived asparaginase.
- Other significant toxicities include pancreatitis, thrombosis, encephalopathy, and liver dysfunction.
- Prompt identification and management of toxicities are essential for treatment adherence.
Conclusions:
- Effective management of asparaginase toxicities is critical for successful pediatric acute lymphoblastic leukemia treatment.
- Strategies to mitigate hypersensitivity and other side effects can improve patient outcomes.
- This review offers guidance for clinicians to optimize asparaginase therapy by addressing its associated toxicities.
Abstract:
Asparaginase is an integral component of multiagent chemotherapy regimens for the treatment of children with acute lymphoblastic leukemia. Positive outcomes are seen in patients who are able to complete their entire prescribed course of asparaginase therapy. Toxicities associated with asparaginase use include hypersensitivity (clinical and subclinical), pancreatitis, thrombosis, encephalopathy, and liver dysfunction. Depending on the nature and severity of the toxicity, asparaginase therapy may be altered or discontinued in some patients. Clinical hypersensitivity is the most common asparaginase-associated toxicity requiring treatment discontinuation, occurring in up to 30% of patients receiving Escherichia coli-derived asparaginase. The ability to rapidly identify and manage asparaginase-associated toxicity will help ensure patients receive the maximal benefit from asparaginase therapy. This review will provide an overview of the common toxicities associated with asparaginase use and recommendations for treatment management.
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