title: Pharmacodynamics and safety of intravenous pegaspargase during remission induction in adults aged 55 years or younger with newly diagnosed acute lymphoblastic leukemia.
abstract: In contrast to that in children, pharmacokinetic, pharmacodynamic, and safety information on pegaspargase in adults is very limited. We administered a single intravenous dose of pegaspargase (2000 IU/m2) as part of a standard frontline induction regimen to 25 adults with newly diagnosed acute lymphoblastic leukemia (ALL), and obtained serum samples on several time points. The population mean peak serum concentration of asparaginase enzymatic activity was 1 IU/mL, the elimination half-life was 7 days, and the volume of distribution was 2.43 L/m2. After the single dose, asparagine deamination was complete in all patients after 2 hours, and in 100%, 81%, and 44% on days 14, 21, and 28, respectively. A pharmocodynamic correlation model showed minimal enzymatic activity of 0.2 IU/mL for optimal asparagine depletion. The kinetic posthoc analyses demonstrated enzymatic activity for 3 weeks or more. One patient developed neutralizing antiasparaginase antibodies on day 22 after administration. Pegaspargase was well tolerated, with few grade 3/4 side effects. No allergic reactions or pancreatitis were observed. In adults aged 55 years or younger, pegaspargase produces a long duration of asparagine depletion and can be given intravenously, with a safety profile that is similar to equivalent multiple doses of intramuscular Escherichia coli asparaginase.
authors.affiliation: Division of Hematology, Department of Medicine, Childrens Hospital Los Angeles, University of Southern California Keck Medical School and Norris Comprehensive Cancer Center, Los Angeles 90033, USA. douer_d@ccnt.hsc.usc.edu
authors.forename: Dan
authors.initials: D
authors.lastname: Douer
authors.forename: Henry
authors.initials: H
authors.lastname: Yampolsky
authors.forename: Lewis J
authors.initials: LJ
authors.lastname: Cohen
authors.forename: Kristy
authors.initials: K
authors.lastname: Watkins
authors.forename: Alexandra M
authors.initials: AM
authors.lastname: Levine
authors.forename: Antonia P
authors.initials: AP
authors.lastname: Periclou
authors.forename: Vassilios I
authors.initials: VI
authors.lastname: Avramis
mesh_terms: D000293:Adolescent; D000328:Adult; D000970:Antineoplastic Agents / Q000009:adverse effects / Q000493:pharmacokinetics / Q000494:pharmacology*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage; D001215:Asparaginase / Q000008:administration & dosage / Q000009:adverse effects / Q000493:pharmacokinetics / Q000494:pharmacology*; D002985:Clinical Protocols; D003630:Daunorubicin / Q000008:administration & dosage; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011092:Polyethylene Glycols / Q000008:administration & dosage / Q000009:adverse effects / Q000493:pharmacokinetics / Q000494:pharmacology*; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000188:drug therapy* / Q000401:mortality; D011241:Prednisone / Q000008:administration & dosage; D012074:Remission Induction / Q000379:methods; D012449:Safety; D015996:Survival Rate; D014750:Vincristine / Q000008:administration & dosage
chemical_list: D000970:Antineoplastic Agents; D011092:Polyethylene Glycols; D014750:Vincristine; C042705:pegaspargase; D001215:Asparaginase; D011241:Prednisone; D003630:Daunorubicin