Asparaginase: Understanding and Overcoming Toxicities

Abstract

Introduction The extension of pediatric-inspired regimens to young adults with newly diagnosed acute lymphoblastic leukemia (ALL) has considerably improved leukemia outcomes in this population,1–3 and nowadays, more young adults are being cured with chemotherapy and successfully spared from complications of early allogeneic hematopoietic cell transplantation consolidation.4 Pediatric-inspired ALL regimens rely heavily on the use of non-myelosuppressive drugs, such as asparaginase, steroid, and vincristine. Asparaginase, in particular, is a key element for pediatric-inspired regimens, and the inclusion of asparaginase and the more extensive use of it in these regimens has led to better ALL outcomes.5,6 In contrast, a summary of approximately 8,000 children enrolled in the Children’s Oncology Group showed a direct correlation between early asparaginase discontinuation as the result of emerging toxicities and inferior outcomes. 7