Management and prevention of pegasparaginase toxicities
| Toxicity . | Management . | Prevention . |
|---|---|---|
| Hypersensitivity | Administer corticosteroid and antihistamine | Pre-medicate with hydrocortisone and antihistamine |
| Replace future doses of l-asparaginase with Erwinia asparaginase | Infuse slowly over 2 h | |
| Hyperbilirubinemia | Adjust other medications and delay subsequent cycle until grade 1 is achieved | Avoid hepatotoxic medications or adjust doses |
| Consider l-carnitine and ursodiol | Not an indication to discontinue pegasparaginase or reduce the dose | |
| Transaminitis | Consider delaying therapy for grades 3 and 4 until resolved to grade 2 | Avoid hepatotoxic medications or adjust doses |
| Consider l-carnitine | Not an indication to discontinue pegasparaginase or reduce dose | |
| Pancreatitis | Early diagnosis and treatment | |
| Supportive medical care | Avoid administering pegasparaginase or any other formulation of asparaginase after clinical asparaginase-associated pancreatitis | |
| Further avoid asparaginase therapy of any form | ||
| No intervention for chemical pancreatitis in the absence of clinical or imaging features | ||
| Hypertriglyceridemia | Consider gemfibrozil | Not an indication to discontinue pegasparaginase |
| Thrombosis | Anticoagulation “not clear” | ATIII replacement for low activity level is not yet standard |
| Maintain adequate platelet counts while patient is receiving anticoagulation | Prophylactic anticoagulation is controversial | |
| Not an indication to discontinue pegasparaginase | ||
| Avoid replacement with cryoprecipitate to correct laboratory abnormalities in the absence of clinical bleed | ||
| Hypofibrinogenemia | Cryoprecipitate replacement only during active bleeding or before procedures | Not an indication to discontinue pegasparaginase |
| Hyperglycemia | Insulin and other anti-glycemic medications | Not an indication to discontinue pegasparaginase |
| Toxicity . | Management . | Prevention . |
|---|---|---|
| Hypersensitivity | Administer corticosteroid and antihistamine | Pre-medicate with hydrocortisone and antihistamine |
| Replace future doses of l-asparaginase with Erwinia asparaginase | Infuse slowly over 2 h | |
| Hyperbilirubinemia | Adjust other medications and delay subsequent cycle until grade 1 is achieved | Avoid hepatotoxic medications or adjust doses |
| Consider l-carnitine and ursodiol | Not an indication to discontinue pegasparaginase or reduce the dose | |
| Transaminitis | Consider delaying therapy for grades 3 and 4 until resolved to grade 2 | Avoid hepatotoxic medications or adjust doses |
| Consider l-carnitine | Not an indication to discontinue pegasparaginase or reduce dose | |
| Pancreatitis | Early diagnosis and treatment | |
| Supportive medical care | Avoid administering pegasparaginase or any other formulation of asparaginase after clinical asparaginase-associated pancreatitis | |
| Further avoid asparaginase therapy of any form | ||
| No intervention for chemical pancreatitis in the absence of clinical or imaging features | ||
| Hypertriglyceridemia | Consider gemfibrozil | Not an indication to discontinue pegasparaginase |
| Thrombosis | Anticoagulation “not clear” | ATIII replacement for low activity level is not yet standard |
| Maintain adequate platelet counts while patient is receiving anticoagulation | Prophylactic anticoagulation is controversial | |
| Not an indication to discontinue pegasparaginase | ||
| Avoid replacement with cryoprecipitate to correct laboratory abnormalities in the absence of clinical bleed | ||
| Hypofibrinogenemia | Cryoprecipitate replacement only during active bleeding or before procedures | Not an indication to discontinue pegasparaginase |
| Hyperglycemia | Insulin and other anti-glycemic medications | Not an indication to discontinue pegasparaginase |