Pegylated L-asparaginase (specialist)

Pegaspargase

Brand names: Oncaspar

Adult dose

Dose: Per ALL protocol — typically 2,500 IU/m² IM/IV q14d

Route: IM / IV infusion

Frequency: q14d per protocol

Clinical pearls

Component of paediatric- and AYA-style protocols for acute lymphoblastic leukaemia
NICE TA408 / haemato-oncology protocols (UKALL14, UKALL2003)
Specialist haematology only; antithrombin replacement may be considered per local protocol

Contraindications

Severe hepatic impairment
History of pancreatitis
History of serious thrombotic event with prior asparaginase
Severe haemorrhagic events
Hypersensitivity

Side effects

Hypersensitivity / anaphylaxis
Pancreatitis
Coagulopathy (low fibrinogen, antithrombin) — thrombosis or haemorrhage
Hepatotoxicity
Hyperglycaemia
Hyperammonaemia

Interactions

Anticoagulants/antiplatelets (bleeding)
Methotrexate
Vincristine

Monitoring

Coagulation (fibrinogen, antithrombin)
LFTs
Lipase/amylase
Glucose
Ammonia
Hypersensitivity observation

Reference: BNF; NICE TA408; UKALL trial protocols; ESMO; SmPC; https://bnf.nice.org.uk/drugs/pegaspargase-specialist-drug/. Verify against your local formulary and the latest BNF before prescribing.

Curated clinical cross-links plus same-class fallbacks.

Pathways