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Asparaginase (Crisantaspase, Erwinase)

Asparaginase is a chemotherapy drug. You might have it as a treatment for acute lymphoblastic leukaemia (ALL).

There are 3 types of asparaginase:

  • asparaginase made from a type of bacteria called Escherichia coli (also known by its brand Spectrila)
  • asparaginase made from the Erwinia chrysanthemia bacteria (Erwinase)
  • long acting (pegylated) asparaginase (also known as pegaspargase)

Pegaspargase (Oncaspar) stays in the body for longer so you may have treatment less often than with asparaginase.

How asparaginase works

All cells need a substance called asparagine to make proteins and create new cells. Asparaginase is an enzyme that breaks down asparagine. Unlike normal cells, ALL cells are unable to make their own asparagine. So asparaginase stops the cancer cells from dividing and growing.

How you have asparaginase

You usually have asparaginase and pegaspargase as an injection into a muscle (intramuscular). You may also have it as a drip into your bloodstream (intravenously) or as an injection under the skin (subcutaneous) but this is rare. How you have it depends on the type of asparaginase used.

Injection into a muscle

You have the injection into a muscle, usually into your buttock or upper thigh.

You might have stinging or a dull ache for a short time after this type of injection, but they don't usually hurt much.

Into your bloodstream

You can have the drug through a thin short tube (a cannula) that goes into a vein in your arm each time you have treatment.

Or you might have it through a long line: a central line, a PICC line or a Portacath.

These are long plastic tubes that give the drug into a large vein in your chest. The tube stays in place throughout the course of treatment.

As an injection under the skin

You usually have injections under the skin (subcutaneous injection) into the stomach, thigh or top of your arm.

You might have stinging or a dull ache for a short time after this type of injection but they don't usually hurt much. The skin in the area may go red and itchy for a while.

When you have asparaginase

You usually have asparaginase every 2 to 3 weeks. You often have it in combination with other chemotherapy drugs such as doxorubicin, methotrexate and cytarabine.

Tests

You have blood tests before and during your treatment. They check your levels of blood cells and other substances in the blood. They also check how well your liver and kidneys are working.

Side effects

We haven't listed all the side effects. It's very unlikely that you will have all of these side effects, but you might have some of them at the same time.

How often and how severe the side effects are can vary from person to person. They also depend on what other treatments you're having. For example, your side effects could be worse if you're also having other drugs or radiotherapy.

When to contact your team

Your doctor, nurse or pharmacist will go through the possible side effects. They will monitor you closely during treatment and check how you are at your appointments. Contact your advice line as soon as possible if:

  • you have severe side effects 
  • your side effects aren’t getting any better
  • your side effects are getting worse

Early treatment can help manage side effects better. 

Contact your doctor or nurse immediately if you have signs of infection, including a temperature above 37.5C or below 36C.

Common side effects

These side effects happen in more than 10 in 100 people (10%). You might have one or more of them. They include:

Increased risk of infection

Increased risk of getting an infection is due to a drop in white blood cells. Symptoms include a change in temperature, aching muscles, headaches, feeling cold and shivery and generally unwell. You might have other symptoms depending on where the infection is.

Infections can sometimes be life threatening. You should contact your advice line urgently if you think you have an infection. 

Blood clots

Blood clots can develop in the deep veins of your body, usually the leg. This is called deep vein thrombosis (DVT). A blood clot can be very serious if it travels to your lungs (pulmonary embolism), although this isn’t common.

Symptoms of a blood clot include:

•    pain, redness and swelling around the area where the clot is and may feel warm to touch
•    breathlessness
•    pain in your chest or upper back – dial 999 if you have chest pain
•    coughing up blood

Tell your doctor immediately or go to A&E if you have any symptoms of a blood clot.

Diarrhoea

Contact your advice line if you have diarrhoea, such as if you've had 4 or more loose watery poos (stools) in 24 hours. Or if you can't drink to replace the lost fluid. Or if it carries on for more than 3 days.

Your doctor may give you anti diarrhoea medicine to take home with you after treatment. Eat less fibre, avoid raw fruits, fruit juice, cereals and vegetables, and drink plenty to replace the fluid lost.

Feeling or being sick

Feeling or being sick is usually well controlled with anti sickness medicines. Avoiding fatty or fried foods, eating small meals and snacks, drinking plenty of water, and relaxation techniques can all help.

It is important to take anti sickness medicines as prescribed even if you don’t feel sick. It is easier to prevent sickness rather than treating it once it has started.

Inflammation of the pancreas

This drug can cause inflammation of the pancreas (pancreatitis). Tell your doctor straight away if you have sudden and severe pain in your tummy (abdomen).

An allergic reaction

A reaction may happen during the infusion, causing a skin rash, itching, swelling of the lips, face or throat, breathing difficulties, fever and chills. Your nurse will give you medicines beforehand to try to prevent a reaction. Tell your nurse or doctor immediately if at any time you feel unwell. They will slow or stop your drip for a while.

Loss of appetite and weight loss

You might not feel like eating and may lose weight. It is important to eat as much as you can. Eating several small meals and snacks throughout the day can be easier to manage. You can talk to a dietitian if you are concerned about your appetite or weight loss. 

High levels of pancreatic and liver enzymes

You might have changes in the levels of pancreatic and liver enzymes such as amylase and lipase. You have regular blood tests during treatment to check for this.

High blood sugar levels

High blood sugar levels can cause headaches, feeling thirsty and blurred vision. You have regular tests to check your blood sugar levels. You may need to check your levels more often if you are diabetic.

Changes to the way your blood clots

You may have changes to the way your blood clots which can cause bleeding and bruising.

Low levels of albumin in your body

Albumin is an important protein in your body. Low levels of albumin can cause weakness, muscle cramps and swelling in different parts of your body. You have regular blood tests to check the albumin levels. 

High levels of bilirubin

You might have high levels of bilirubin in your blood. You will have regular blood tests to check the bilirubin levels. 

High blood cholesterol

Cholesterol is a fatty substance which helps cells in the body to work normally. When the cholesterol level is too high it could have an effect on your heart. You usually have blood tests to check your cholesterol levels.

Skin rash

Skin problems include a skin rash, dry skin and itching. This usually goes back to normal when your treatment finishes. Your nurse will tell you what products you can use on your skin to help.

Tiredness (fatigue)

You might feel very tired and as though you lack energy.

Various things can help you to reduce tiredness and cope with it, for example exercise. Some research has shown that taking gentle exercise can give you more energy. It is important to balance exercise with resting.

Occasional side effects

These side effects happen in between 1 and 10 out of every 100 people (1 to 10%). You might have one or more of them. They include:

  • a drop in the level of platelets which can cause bruising and bleeding
  • feeling breathless and looking pale due to a drop in red blood cells
  • mouth sores and ulcers
  • a build up of fluid in your tummy (abdomen)
  • liver damage which usually gets better when you stop treatment
  • a severe infection called sepsis which can be life threatening if not treated early
  • pain in your arms and legs
  • seizures (fits)
  • numbness and tingling in your feet or hands
  • fainting or passing out
  • drop in the levels of oxygen in your body
  • low mood (depression) and sleepiness
  • confusion and seeing or hearing things that are not there (hallucinations)
  • dizziness

Rare side effects

These side effects happen in fewer than 1 in 100 people (1%). You might have one or more of them. They include:

  • bleeding in your pancreas
  • yellowing of the skin and the whites of your eyes (jaundice) due to a build up of bilirubin in your body
  • severe liver problems such as liver failure which can be life threatening if not treated early
  • a collection of symptoms called posterior reversible encephalopathy which can cause headaches, fits, confusion, and loss of vision
  • a severe and potentially life threatening allergic reaction called anaphylaxis – your treatment team will monitor you closely while you are having this treatment

Coping with side effects

We have more information about side effects and tips on how to cope with them.

What else do I need to know?

Other medicines, foods and drinks

Cancer drugs can interact with some other medicines and herbal products. Tell your doctor or pharmacist about any medicines you are taking. This includes vitamins, herbal supplements and over the counter remedies.

Loss of fertility

It is not known whether this treatment affects fertility in people. Talk to your doctor before starting treatment if you think you may want to have a baby in the future.

Contraception and pregnancy

It is unknown whether treatment may or may not harm a baby developing in the womb. It is important not to become pregnant or father a child while you are having treatment.

Talk to your doctor or nurse about effective contraception you can use during treatment. Ask how long you should use it before starting treatment and after treatment has finished.

Breastfeeding

It is not known whether this drug comes through into the breast milk. Doctors usually advise that you don’t breastfeed during this treatment.

Treatment for other conditions

Always tell other doctors, nurses, pharmacists or dentists that you’re having this treatment if you need treatment for anything else, including teeth problems.

Immunisations

Don’t have immunisations with live vaccines while you’re having treatment and for up to 12 months afterwards. The length of time depends on the treatment you are having. Ask your doctor or pharmacist how long you should avoid live vaccinations.

In the UK, live vaccines include rubella, mumps, measles, BCG, yellow fever and the shingles vaccine (Zostavax).

You can:

  • have other vaccines, but they might not give you as much protection as usual
  • have the flu vaccine (as an injection)

Contact with others who have had immunisations - You can be in contact with other people who have had live vaccines as injections. Avoid close contact with people who have recently had live vaccines taken by mouth (oral vaccines) such as the oral typhoid vaccine.

If your immune system is severely weakened, you should avoid contact with children who have had the flu vaccine as a nasal spray. This is for 2 weeks following their vaccination.

Babies have the live rotavirus vaccine. The virus is in the baby’s poo for about 2 weeks and could make you ill if your immunity is low. Get someone else to change their nappies during this time if you can. If this isn't possible, wash your hands well after changing their nappy.

More information about this treatment

For further information about this treatment go to the electronic Medicines Compendium (eMC) website.

You can report any side effect you have to the Medicines Health and Regulatory Authority (MHRA) as part of their Yellow Card Scheme.

Information and help