Evaluating asparaginase toxicity in Hispanic patients with acute lymphoblastic leukemia in a large safety-net hospital.

Abstract

e19012 Background: Asparaginase has been a common component of induction therapy for acute lymphoblastic leukemia (ALL) patients for decades. The use of asaparaginase in the treatment of ALL has shown significant efficacy leading to improved outcomes when used in combination with chemotherapy in children. Despite these results, this medication is not used ubiquitously due to its toxicity profile in adults that includes hepatotoxicity, thrombosis, pancreatitis, and allergic reactions. Established risk factors for increased toxicity are increased age, obesity, and higher doses. Our study aims at reviewing the toxicity profile of this medication in Hispanic patients. We suspected that our patient population will have a higher incidence of various toxicities due to the higher prevalence of obesity and liver disease in this population. Methods: We performed a retrospective chart review of all patients aged greater than 18 years who presented to Harbor-UCLA Medical Center between 2015 and 2021 and were diagnosed with ALL who were given a treatment regimen that included asparaginase. We collected information about demographics, laboratory parameters on diagnosis, treatment details, and information on complications related to the treatment. Results: A total of 14 patients diagnosed with ALL and treated with asparaginase at Harbor-UCLA Medical Center from January 2016-November 2021 were included in this study. Our cohort consists of 53% males and 46% females, with an average age of 31 (SD 9.4). Our patient population had an average of BMI of 34 (SD 8.7), with the majority, 9 out of 14, being classified as obese. The majority of the cohort was Philadelphia chromosome negative (80%). In our study, the incidence of grade 3 to 4 hyperbilirubinemia was 6 out of 14 patients (42%). Half of our patients who suffered from hyperbilirubinemia suffered from class III obesity. The incidence of grade 3 to 4 transaminitis was 13 out of 14 patients (93%). A total of 5 out of 14 patients (36%) also suffered from thrombosis. One patient (7%) had a hypersensitivity reaction. Conclusions: Our incidence of hyperbilirinemia is higher than previously published incidence values. Various studies have shown different incidence rates ranging between 14-40%. Our patient population did experience severe transaminitis in a much higher rate than previously reported rates of around 50%. The higher incidence noted in our patients with class III obesity is in line with recent expert recommendations for dose reduction of asparaginase in patients with severe obesity. We have concluded from our study that our Hispanic population is at higher risk for developing hepatotoxicity after asparaginase use but could be related to the high prevalence of obesity in our population. This is important for future patient care to appropriately select candidates for this intensive therapy and reduce the risk of severe adverse events.