Drug type
• Contains an asparaginase-specific enzyme derived from Erwinia chrysanthemi.
• L-asparaginase is a tetrameric enzyme consisting of four identical subunits, each having a molecular weight of about 35 kDa.
• Activity is expressed in terms of International Units (IU).
Indications
• A component of a multiagent chemotherapeutic regimen for treatment acute lymphoblastic leukemia (ALL) in patients with a hypersensitivity to Escherichia coli-derived asparaginase.
Mechanism of action
• Catalyzes the deamidation of asparagine to aspartic acid and ammonia, resulting in reduced circulating levels of asparagine.
• Mechanism of action may be based on inability of leukemic cells to synthesize asparagine due to lack of asparagine synthetase activity
• Result is cytotoxicity specific for leukemic cells that depend on an exogenous source of the amino acid asparagine for their protein metabolism and survival
Dosage and administration
• To substitute for a dose of pegaspargase:
— Recommended dose is 25,000 IU/m2 administered intramuscularly three times a week (Monday/Wednesday/Friday) for six doses for each planned dose of pegaspargase
• To substitute for a dose of native E coli asparaginase:
— Recommended dose is 25,000 IU/m2 administered intramuscularly for each scheduled dose of native E coli asparaginase within a treatment.
• Limit the volume administered to 2 mL per injection site. If required dose is more than 2 mL, use multiple injection sites.
Pregnancy and lactation
• Pregnancy category C
• Lactation: not known if distributed in breast milk
— Use caution
Cautions
• Serious hypersensitivity reactions, including anaphylaxis
• Pancreatitis
• Glucose intolerance
• Thrombosis and hemorrhage
Adverse effects
• Most common adverse reactions (incidence >1%):
— Abnormal transaminases
— Coagulation abnormalities including thrombosis and hemorrhage
— Hyperglycemia
— Nausea and vomiting
— Pancreatitis
— Serious hypersensitivity reactions, including anaphylaxis
Drug interactions
— No formal drug interaction studies have been performed.
What to tell your patient
• This medication, asparaginase Erwinia chrysanthemi, is used along with other chemotherapy agents to treat acute lymphoblastic leukemia (ALL).
• It is indicated for patients who have developed a hypersensitivity to asparaginase and pegaspargase, which are made with a protein taken from the bacterium E coli. Asparaginase Erwinia chrysanthemi is made with a different protein, from the bacterium Erwinia chrysanthemi.