Asparlas
Asparlas (calaspargase pegol) is a chemotherapy medication used to treat children and young adults aged 1 month to 21 years with acute lymphoblastic leukemia (ALL). It’s typically given together with other chemotherapy medications. Compared to other asparaginase treatments, Asparlas (calaspargase pegol) stays in the body the longest. The medication is given as an injection into the vein (intravenous, IV), usually no more than every 3 weeks. Some side effects include pancreatitis, serious liver problems, and blood clots.
What is Asparlas (calaspargase pegol)?
What is Asparlas (calaspargase pegol) used for?
Treatment of children and young adults aged 1 month to 21 years with acute lymphoblastic leukemia (ALL) given together with other chemotherapy medications
How Asparlas (calaspargase pegol) works
Asparlas (calaspargase pegol) is an asparagine specific enzyme. It works by targeting asparagine, a nutrient that cancer cells need to survive. By breaking down asparagine, Asparlas (calaspargase pegol) prevents cancer cells from using it, which helps stop them from growing and spreading.
Drug Facts
What are the side effects of Asparlas (calaspargase pegol)?
Common Side Effects
- High liver enzymes (52%)
- High bilirubin (20%)
- Pancreatitis (18%)
- Abnormal clotting labs (14%)
- Diarrhea (9%)
- Allergic reaction (8%)
- Blood clot (8%)
Other Side Effects
- Sepsis
- Trouble breathing
- Bleeding
- Fungal infection
- Pneumonia
- Heart rhythm changes
Serious Side Effects
- Serious allergic reaction: trouble breathing, hives, itching, facial swelling, dizziness, fainting
- Pancreatitis: severe stomach pain, fever, nausea, vomiting, chills, diarrhea
- Blood clots: sudden and severe headache, swelling in the arms or legs, trouble breathing, chest pain
- Severe liver problems: sudden weight gain, stomach pain or swelling, nausea, vomiting, yellowing of the skin or the whites of the eyes
Source: DailyMed
The following side effects have also been reported
Side effects that you should report to your care team as soon as possible:
- Allergic reactions or angioedema—skin rash, itching or hives, swelling of the face, eyes, lips, tongue, arms, or legs, trouble swallowing or breathing
- Bleeding—bloody or black, tar-like stools, vomiting blood or brown material that looks like coffee grounds, red or dark brown urine, small red or purple spots on skin, unusual bruising or bleeding
- Blood clot—pain, swelling, or warmth in the leg, shortness of breath, chest pain
- Infusion reactions—chest pain, shortness of breath or trouble breathing, feeling faint or lightheaded
- Liver injury—right upper belly pain, loss of appetite, nausea, light-colored stool, dark yellow or brown urine, yellowing skin or eyes, unusual weakness or fatigue
- Pancreatitis—severe stomach pain that spreads to your back or gets worse after eating or when touched, fever, nausea, vomiting
Side effects that usually do not require medical attention (report to your care team if they continue or are bothersome):
Pros and cons of Asparlas (calaspargase pegol)
Pros
Recommended as part of combination therapy for ALL in children and young adults
Works well for treating ALL, with 95% of people in studies achieving complete remission
Typically only given once every 3 weeks
Cons
Given as an intravenous injection, so it requires a needle
Not FDA approved for adults older than 21 years with ALL
Might cause serious side effects such as pancreas or liver problems
Pharmacist tips for Asparlas (calaspargase pegol)
Because Asparlas (calaspargase pegol) can cause allergic reactions, you'll need to take premedications like acetaminophen (Tylenol), diphenhydramine (Benadryl), and famotidine (Pepcid) 30 to 60 minutes before each dose. If you experience symptoms like trouble breathing, lip or eye swelling, itchiness, or rash during or shortly after your treatment, tell your care team right away.
Asparlas (calaspargase pegol) is usually given together with several other chemotherapy medications as part of a complex treatment regimen. The treatment schedule can be complicated and confusing. Consider using a treatment calendar or an app on your phone to help you keep track of appointments.
Expect your Asparlas (calaspargase pegol) infusion to take at least 1 hour. But, since you'll also receive premedications and other chemotherapy drugs, plan for the entire treatment to take half a day or more.
Asparlas (calaspargase pegol) can cause pancreatitis, or swelling of the pancreas. Seek medical help if you have symptoms such as severe stomach pain, fever, nausea and vomiting that won’t stop, and diarrhea.
Asparlas (calaspargase pegol) can cause serious liver problems, so you’ll need to get regular labs done to check your liver health. If your liver enzymes are too high, you might need to pause. If you experience symptoms like yellow eyes, yellow skin, stomach pain, or a swollen belly, contact your care team right away.
If you can become pregnant, use non-hormonal birth control while you’re taking Asparlas (calaspargase pegol). You’ll also need to continue to use birth control for at least 3 months after you stop treatment.
It’s best to avoid breastfeeding while you’re taking Asparlas (calaspargase pegol) and for at least 3 months after your last dose, as there are potential risks to the baby.
Frequently asked questions about Asparlas (calaspargase pegol)
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What are the risks and warnings for Asparlas (calaspargase pegol)?
Asparlas (calaspargase pegol) can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.
Allergic reactions
People taking Asparlas (calaspargase pegol) can develop serious allergic reactions. These reactions can include rash, trouble breathing, facial swelling, hives, itching, or low blood pressure. To help prevent these reactions, you’ll take premedications such as acetaminophen (Tylenol), diphenhydramine (Benadryl), and famotidine (Pepcid) 30 to 60 minutes before each dose. You might have to stay in the clinic for an hour after your dose to make sure you don’t experience any reactions. If you have a serious reaction, you likely won’t be able to continue taking this medication
Pancreatitis
People taking Asparlas (calaspargase pegol) have developed pancreatitis, a condition where your pancreas becomes irritated and swollen. If not managed quickly, the pancreas can start bleeding and some pancreas cells can die, which can be life threatening. Contact your oncologist if you develop symptoms such as fever, nausea and vomiting, and severe stomach pain in the upper belly area. You might need to pause taking this medication while your oncologist looks into it. If they determine that you do have pancreatitis, you might need to stop taking Asparlas (calaspargase pegol) altogether.
Blood clots
Some people taking Asparlas (calaspargase pegol) have developed blood clots. If you have swelling, warm skin, or redness in one arm or one leg, trouble breathing, a sudden and severe headache, or weakness on one side of your body, get medical help right away.
Bleeding
Some people taking Asparlas (calaspargase pegol) have had lab tests showing problems with blood clotting. This means your body might have trouble stopping bleeding. If you experience bleeding that won’t stop or notice more bruising, let your care team know.
Liver problems
Asparlas (calaspargase pegol) can cause serious liver problems, some even life-threatening. Your oncologist will monitor your liver health on a regular basis to make sure this medication is still safe for you to take. If your liver labs are too high, you might need to pause or stop treatment. If you experience symptoms of liver problems such as stomach pain, sudden weight gain, yellowing of the skin, or yellowing around the whites of your eyes, call your oncologist right away.
Asparlas (calaspargase pegol) dosage forms
Typical dosing for Asparlas (calaspargase pegol)
Your provider will calculate your dose of Asparlas (calaspargase pegol) based on your body surface area (BSA), which takes into account your height and weight.
The typical dose is 2,500 units/m^2 given intravenously no more often than every 3 weeks.
Asparlas (calaspargase pegol) contraindications
History of serious blood clot to L-asparaginase treatment
History of pancreatitis to L-asparaginase treatment
History of bleeding to L-asparaginase treatment
Severe liver problems
What are alternatives to Asparlas (calaspargase pegol)?
Treatment of children and young adults aged 1 month to 21 years with acute lymphoblastic leukemia (ALL) given together with other chemotherapy medications
Treatment of children and adults with acute lymphoblastic leukemia (ALL) as part of a combination chemotherapy regimen
Treatment of children and adults 1 month and older with acute lymphoblastic leukemia (ALL) or lymphoblastic lymphoma (LBL) given together with other chemotherapy medications
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References
Best studies we foundAmerican Cancer Society. (n.d.). Chemotherapy.
American Cancer Society. (2018). Chemotherapy for acute lymphocytic leukemia (ALL).
Büchler, M. W., et al. (2000). Acute necrotizing pancreatitis: Treatment strategy according to the status of infection. Annals of Surgery.
Evans, R. P., et al. (2017). Pancreatitis: Preventing catastrophic haemorrhage. World Journal of Gastroenterology.
Krall, A. S., et al. (2016). Asparagine promotes cancer cell proliferation through use as an amino acid exchange factor. Nature Communications.
Leukemia & Lymphoma Society. (n.d.). Acute lymphoblastic leukemia.
Maese, L., et al. (2022). Current use of asparaginase in acute lymphoblastic leukemia/lymphoblastic lymphoma. Frontiers in Pediatrics.
National Cancer Institute. (n.d.). Hepatic veno-occlusive disease.
National Comprehensive Cancer Network. (2023). Pediatric acute lymphoblastic leukemia.
Pui, C. H., et al. (2018). How to solve the problem of hypersensitivity to asparaginase? Pediatric Blood & Cancer.
Servier Pharmaceuticals LLC. (2024). Asparlas- calaspargase pegol injection, solution [package insert]. DailyMed.
U.S. Food and Drug Administration. (2018). FDA approves longer-acting calaspargase pegol-mknl for ALL.
Vrooman, L. M., et al. (2021). Efficacy and toxicity of pegaspargase and calaspargase pegol in childhood acute lymphoblastic leukemia: Results of DFCI 11-001. Journal of Clinical Oncology.
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