Asparaginase therapy in patients with acute lymphoblastic leukemia: expert opinion on use and toxicity management

Abstract

The addition of asparaginase to acute lymphoblastic leukemia (ALL) and lymphoblastic lymphoma (LBL) treatment regimens provides significant patient benefits. Asparaginase therapies vary in origin (Escherichia coli– or Erwinia-derived) and preparation (native or pegylated), conferring distinct pharmacokinetic and immunogenic profiles. Clinical hypersensitivity reactions (HSRs) are commonly reported in patients and range from localized erythema to systemic anaphylaxis. Due to its favorable pharmacokinetic profile and reduced immunogenicity compared to native E. coli preparations, pegaspargase is the first-line asparaginase therapeutic option. Switching to an Erwinia-derived asparaginase is recommended for patients who experience HSRs or antibody-mediated inactivation to achieve the significant clinical benefit observed in patients who complete asparaginase treatment. Previous global shortages of asparaginase Erwinia chrysanthemi necessitated conversion mitigation strategies such as premedication protocols, desensitization, and asparaginase activity level monitoring. Here, we discuss the efficacy, safety, pharmacokinetics, current use, and administration of asparaginase therapies for pediatric and adolescent patients with ALL/LBL.

Keywords:

• Allergy and hypersensitivity
• lymphoid leukemia
• chemotherapeutic approaches
• pharmacotherapeutics

Acknowledgments

Medical writing and editorial assistance were provided by Michelle Preston, MSc (Lumanity Scientific Inc.), and were financially supported by Jazz Pharmaceuticals.

Disclosure statement

No potential conflict of interest was reported by the authors.

Data availability statement

Data sharing not applicable—no new data generated.

Additional information

Funding

The author(s) reported there is no funding associated with the work featured in this article.