Lymphoblastic lymphoma (LBL)

Active Ingredient: Asparaginase

Indication for Asparaginase

Population group: only infants (40 days - 1 year old) , children (1 year - 12 years old) , adolescents (12 years - 18 years old) , adults (18 years old or older)
Therapeutic intent: Curative procedure

Asparaginase is indicated as a component of a multi-agent chemotherapeutic regimen for the treatment of lymphoblastic lymphoma (LBL) in adult and paediatric patients (1 month and older) who developed hypersensitivity or silent inactivation to E. coli-derived asparaginase.

For this indication, competent medicine agencies globally authorize below treatments:

25 mg/m² every 48 hours or 25 mg/m² every Monday, Wednesday and Friday

For:

Dosage regimens

Regimen A, in case that patient age in months is ≥ 1

Intramuscular, 25 milligrams asparaginase per square meter of body surface, once every 48 hours.

Regimen B, in case that patient age in months is ≥ 1

Intravenous, 25 milligrams asparaginase per square meter of body surface, once every 48 hours.

Regimen C, in case that patient age in months is ≥ 1

Intramuscular, 25 milligrams asparaginase per square meter of body surface, one dose, over the duration of 2 days. Afterwards, intramuscular, 25 milligrams asparaginase per square meter of body surface, one dose, over the duration of 2 days. Afterwards, intramuscular, 50 milligrams asparaginase per square meter of body surface, one dose, over the duration of 3 days.

Regimen D, in case that patient age in months is ≥ 1

Intravenous, 25 milligrams asparaginase per square meter of body surface, one dose, over the duration of 2 days. Afterwards, intravenous, 25 milligrams asparaginase per square meter of body surface, one dose, over the duration of 2 days. Afterwards, intramuscular, 50 milligrams asparaginase per square meter of body surface, one dose, over the duration of 3 days.

Regimen E, in case that patient age in months is ≥ 1

Intravenous, 25 milligrams asparaginase per square meter of body surface, one dose, over the duration of 2 days. Afterwards, intravenous, 25 milligrams asparaginase per square meter of body surface, one dose, over the duration of 2 days. Afterwards, intravenous, 50 milligrams asparaginase per square meter of body surface, one dose, over the duration of 3 days.

Detailed description

The recommended dose of asparaginase is:

  • Every 48 hours
    • 25 mg/m² intramuscularly or intravenously

Or

  • Monday/Wednesday/Friday
    • 25 mg/m² intramuscularly on Monday and Wednesday, and 50 mg/m² intramuscularly on Friday; or
    • 25 mg/m² intravenously on Monday and Wednesday, and 50 mg/m² intramuscularly on Friday; or
    • 25 mg/m² intravenously on Monday and Wednesday, and 50 mg/m² intravenously on Friday

Recommended premedication

A consideration to premedicate patients with paracetamol, an H1 receptor blocker, and an H2 receptor blocker 30–60 minutes prior to administration should be made when asparaginase is being given intravenously to decrease the risk and severity of infusion related reaction/hypersensitivity reaction.

Recommended monitoring

Asparaginase activity can vary between individuals, therefore trough SAA should be monitored. When administered every 48 hours a trough asparaginase activity measurement should be performed at 48 hours post dose. When dosing on a Monday/Wednesday/Friday schedule, trough SAA should be measured 72 hours after the Friday dose and prior to administration of the following Monday dose. The dosing schedule or route of administration should then be individually adapted.

Therapy can be further adjusted according to local treatment protocols.

Dosage considerations

Asparaginase is for intramuscular and/or intravenous use.

For intramuscular use, limit the volume of asparaginase at a single injection site to 2 mL for patients with a body surface area (BSA) >0.5 m², for patients with a BSA <0.5 m² limit the volume to 1 mL. If the volume to be administered is greater than the mentioned limits, use multiple injection sites.

For intravenous infusion, it is recommended to administer the dose over 2 hours.

Active ingredient

Asparaginase

Asparaginase hydrolyses asparagine to aspartic acid and ammonia. In contrast to normal cells, lymphoblastic tumour cells have a very limited capacity for synthesising asparagine because of a significantly reduced expression of asparagine synthetase. Therefore, they require asparagine which diffuses from the extracellular environment. As a result of asparaginase-induced asparagine depletion in serum, protein synthesis in lymphoblastic tumour cells is disturbed while sparing most normal cells.

Read more about Asparaginase

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