Asparaginase is part of treatment for acute lymphocytic leukemia (ALL) and is associated with improved outcomes in those who complete this course of treatment. Despite the necessity of PEG-asparaginase, 20%–30% of patients can experience toxicities.

Researchers assessed a different infusion technique and observed a statistically and clinically significant reduced rate of adverse events (AEs) in patients receiving PEG-asparaginase with a normal saline infusion compared with those receiving the treatment without fluids. Faina Shenderov, PharmD, BCOP, BCNSP, CNSC, and Anne Schaefer, MD, presented the results in “Study on Prevention of PEG-asparaginase Associated Toxicities” as part of the e-poster sessions on November 2 and 3 during the 2018 JADPRO Live conference in Hollywood, FL.

Researchers conducted a retrospective analysis of 58 patients receiving PEG-asparaginase between September 1, 2014, and July 30, 2017: 37 patients received PEG-asparaginase as an IV piggy-back (IVPB) alone and 21 received PEG-asparaginase through the tubing of a freely infusing solution of normal saline.

AEs occurred in 18.6% of patients receiving PEG-asparaginase IVPB alone and in 1.6% of those receiving it through a running IV line (p = 0.0072). Among those not receiving fluids, four patients experienced grade 3 hypersensitivity during consolidation, one during induction, and one during delayed intensification. Just one patient receiving PEG-asparaginase with normal saline experienced a reaction.

Increased antiemetic use occurred in 18 of 104 IVPB doses (18.4%) compared with one of 64 normal saline doses (1.6%).

The researchers pointed to an improved quality of life and reduced costs with PEG-asparaginase plus normal saline because the use of the more expensive alternative Erwinia asparaginase was avoided.