title: Prevention and management of asparaginase/pegasparaginase-associated toxicities in adults and older adolescents: recommendations of an expert panel.
abstract: The rapidly increasing use of pegasparaginase (pegASNase) in adults, after a half century of use of asparaginase (ASNase) in children, has prompted a need for guidelines in the management and prevention of toxicities of asparagine depletion in adults. Accordingly, an initial set of recommendations are provided herein. Major advantages of pegASNase are its 2-3-week duration of action, in contrast to less than 3 days with native ASNase, and the flexibility of intravenous or intramuscular administration of pegASNase and associated patient and physician convenience. The most frequent toxicities of both types of ASNase are hepatic and pancreatic, with pancreatitis being the most serious. Other toxicities are hypersensitivity reactions, thrombosis, nausea/vomiting, and fatigue. Whether or not the replacement of one dose of pegASNase for 6-9 doses of native ASNase can be achieved in adults with similar efficacy and acceptable toxicities to those achieved in children remains to be established.
authors.affiliation: University of Chicago, Chicago, IL, USA.
authors.forename: Wendy
authors.initials: W
authors.lastname: Stock
authors.forename: Dan
authors.initials: D
authors.lastname: Douer
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: DeAngelo
authors.forename: Martha
authors.initials: M
authors.lastname: Arellano
authors.forename: Anjali
authors.initials: A
authors.lastname: Advani
authors.forename: Lloyd
authors.initials: L
authors.lastname: Damon
authors.forename: Tibor
authors.initials: T
authors.lastname: Kovacsovics
authors.forename: Mark
authors.initials: M
authors.lastname: Litzow
authors.forename: Michael
authors.initials: M
authors.lastname: Rytting
authors.forename: Gautam
authors.initials: G
authors.lastname: Borthakur
authors.forename: Archie
authors.initials: A
authors.lastname: Bleyer
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000009:adverse effects*; D001215:Asparaginase / Q000008:administration & dosage / Q000009:adverse effects*; D006801:Humans; D011092:Polyethylene Glycols / Q000008:administration & dosage / Q000009:adverse effects*; D017410:Practice Guidelines as Topic; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000188:drug therapy*
chemical_list: D000970:Antineoplastic Agents; D011092:Polyethylene Glycols; C042705:pegaspargase; D001215:Asparaginase