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Optimizing pegylated asparaginase use: An institutional guideline for dosing, monitoring, and management
Najeebah A Bade1,2, Crystal Lu2, Ciera L Patzke3,4
1Division of Hematology/Oncology, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA.
Insights
L-asparaginase improves survival in adult acute lymphoblastic leukemia but causes toxicities. This article shares a guideline to manage these adverse events, aiming to enhance patient safety and treatment outcomes.
Area of Science:
- Oncology
- Hematology
Background:
- L-asparaginase and pegylated asparaginase improve survival in adult acute lymphoblastic leukemia (ALL).
- Asparaginase use necessitates vigilant management of adverse effects like hypersensitivity, hepatotoxicity, pancreatitis, coagulopathy, and thrombosis.
- Limited literature exists for managing these specific toxicities.
Purpose of the Study:
- To present a standard of practice guideline for preventing and managing asparaginase-related adverse events.
- To share long-term clinical experience with asparaginase products and their induced toxicities.
- To improve patient safety and optimize treatment outcomes in adult ALL patients.
Main Methods:
- Development of a standard of practice guideline at the University of Maryland Marlene and Stewart Greenebaum Comprehensive Cancer Center.
- Review of clinical experience with asparaginase products and management of associated toxicities.
Main Results:
- A guideline was created to address the prevention and management of asparaginase-induced toxicities.
- Sharing clinical experience aims to provide practical guidance for healthcare providers.
Conclusions:
- Effective management of asparaginase-related adverse events is crucial for optimizing treatment outcomes in adult ALL.
- The presented guideline and shared experience can improve patient safety and clinical practice.
Abstract:
The incorporation of L-asparaginase and pegylated asparaginase into pediatric-inspired regimens has conferred a survival advantage in treatment of adults with acute lymphoblastic leukemia. Use of asparaginase products requires careful prevention, monitoring, and management of adverse effects including hypersensitivity, hepatotoxicity, pancreatitis, coagulopathy, and thrombosis. Currently, there is limited published literature to offer guidance on management of these toxicities. At the University of Maryland Marlene and Stewart Greenebaum Comprehensive Cancer Center, a standard of practice guideline was created to prevent and manage asparaginase-related adverse events. By sharing our long-term experience with asparaginase products and clinical management of asparaginase-induced toxicities, this article aims to improve patient safety and optimize treatment outcomes.
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