L Asparaginase Escherichia coli Brand Name– Elspar
What is L Asparaginase Escherichia coli
L Asparaginase Escherichia coli is an enzyme that is used as an antineoplastic agent to treat acute lymphocytic leukemia (ALL).
Commonly in clinical use, L-asparaginase Escherichia coli is purified from Escherichia coli, although L-asparaginase is available from multiple other sources including Erwinia carotovora (also known as chrysanthemi), Serratia marcescens, and guinea pig serum.
Patients developing an allergic reaction to E.coli preparations may tolerate the Erwinia formulation (see separate monograph). As a single agent, L-asparaginase induces remission in 50—60% of ALL patients; however, these remissions are short-lived, only 1—8 months.
Therefore, L-asparaginase usually is administered in combination with other drugs (e.g., vincristine and prednisone).
L-Asparaginase has no activity in solid tumors; a few responses have been noted in patients with acute myeloid leukemia, chronic myeloid leukemia in blast crisis, or non-Hodgkin’s lymphoma treated with L-asparaginase.
The FDA approved L-asparaginase Escherichia coli in 1978.
Indications
- acute lymphocytic leukemia (ALL)
NOTE: Asparaginase Erwinia chrysanthemi and pegaspargase are discussed in separate monographs.
For the induction of remission of acute lymphocytic leukemia (ALL) in combination with other chemotherapeutic agents
Side Effects
- agitation
- anaphylactoid reactions
- antibody formation
- azotemia
- coagulopathy
- coma
- confusion
- depression
- diabetic ketoacidosis
- EEG changes
- elevated hepatic enzymes
- encephalopathy
- fatigue
- hallucinations
- hepatic failure
- hyperammonemia
- hyperbilirubinemia
- hypercholesterolemia
- hyperglycemia
- hyperlipidemia
- hypertension
- hypertonia
- hypertriglyceridemia
- hypoalbuminemia
- hypoprothrombinemia
- impaired cognition
- intracranial bleeding
- irritability
- lethargy
- pancreatitis
- prolonged bleeding time
- seizures
- thrombosis
- tremor
- visual impairment
Monitoring Parameters
- blood glucose
- CBC with differential
- D-dimer
- fibrinogen
- LFTs
- serum albumin
- serum creatinine/BUN
- serum uric acid
- thrombin time
Contraindications
- bleeding
- breast-feeding
- coagulopathy
- diabetes mellitus
- diabetic ketoacidosis
- E. coli protein hypersensitivity
- encephalopathy
- hepatic disease
- herpes infection
- hyperkalemia
- hyperphosphatemia
- hypertension
- hyperuricemia
- hypoalbuminemia
- hypocalcemia
- hypofibrinogenemia
- infection
- intracranial bleeding
- L-asparaginase hypersensitivity
- pancreatitis
- pregnancy
- requires a specialized care setting
- seizures
- thromboembolic disease
- tumor lysis syndrome (TLS)
- varicella
- viral infection
Interactions
- Alpha interferons
- Anticoagulants
- Antithrombin III
- Antithymocyte Globulin
- Apixaban
- Argatroban
- Betrixaban
- Bivalirudin
- Carbamazepine
- Clozapine
- Corticosteroids
- Cytarabine, ARA-C
- Dabigatran
- Dalteparin
- Danaparoid
- Desirudin
- Echinacea
- Edoxaban
- Enoxaparin
- Febuxostat
- Filgrastim, G-CSF
- Fondaparinux
- Heparin
- Interferon Alfa-2a
- Interferon Alfa-2b
- Interferon Alfa-2b; Ribavirin
- Interferon Alfa-n3
- Interferon Alfacon-1
- Lepirudin
- Methotrexate
- Palifermin
- Pegfilgrastim
- Peginterferon Alfa-2a
- Peginterferon Alfa-2b
- Penicillamine
- Pentosan
- Rivaroxaban
- Tbo-Filgrastim
- Thyroid hormones
- Tinzaparin
- Tuberculin Purified Protein Derivative, PPD
- Vincristine
- Vincristine Liposomal
- Warfarin
- Zonisamide
