Crisantaspase (Erwinase®, asparaginase or L-asparaginase)
Crisantaspase is a chemotherapy drug that's used to treat acute lymphoblastic leukaemia (ALL). Throughout this information we refer to it by its more common name asparaginase.
This information should ideally be read with our general information about chemotherapy and your type of cancer or leukaemia.
You'll see your hospital doctor regularly while you have this treatment so they can monitor the effects of the chemotherapy.
What asparaginase looks like
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Asparaginase is a colourless fluid.
Asparaginase is given in one of the following ways:
as an injection through a fine tube (cannula) inserted into a vein (intravenously), usually in the back of your hand
through a fine plastic tube inserted under the skin and into a vein near your collarbone (central line)
into a fine tube inserted into a vein in the crook of your arm (PICC line)
as a drip (infusion) through a cannula
by injection into a muscle (intramuscular injection)
by injection under the skin (subcutaneous injection).
Chemotherapy is usually given as a course of several sessions (cycles) of treatment over a few months. The length of your treatment and the number of cycles you have will depend on the type of cancer you're being treated for. Your nurse or doctor will discuss your treatment plan with you.
Before you have your treatment, your doctor will arrange for you to have blood tests. You'll usually be given anti-sickness drugs before and/or during your treatment.
Feeling sick (nausea) and being sick (vomiting)
This may begin soon after the treatment is given and can last for a few days. Your doctor can prescribe very effective anti-sickness (anti-emetic) drugs to prevent or greatly reduce nausea and vomiting. If the sickness isn't controlled, or if it continues, tell your doctor - they can prescribe other anti-sickness drugs that may be more effective.
Some anti-sickness drugs can cause constipation. Let your doctor or nurse know if this is a problem.
Loss of appetite
Some people lose their appetite while having chemotherapy. This can be mild and may only last a few days. If it doesn’t improve, you can ask to see a dietitian or specialist nurse at your hospital. They can give you advice on improving your appetite and keeping to a healthy weight. You might find our section on eating well useful.
Changes in blood clotting
The liver produces particular proteins (factors) that affect blood clotting. Asparaginase causes either more or fewer blood-clotting factors to be produced. If fewer blood-clotting factors are produced, there may be a slight chance of more bleeding or bruising than usual - although this isn't common. Tell your doctor if you notice any bleeding or bruising.
If too many clotting factors are produced, there may be a risk of blood clots (thrombosis). Tell your doctor as soon as possible if you have any pain, heat, redness or swelling in a limb, as these could be signs of a blood clot. Also let your doctor know about any headaches, nosebleeds, dizziness or feelings of confusion.
Treatment with asparaginase may cause changes in the way your liver works, although it will return to normal when the treatment finishes. You're very unlikely to notice any problems, but your doctor will take regular blood samples to check your liver is working properly.
Feeling tired is a common side effect of chemotherapy, especially towards the end of treatment and for some weeks after it’s over. It’s important to try to pace yourself and get as much rest as you need. Try to balance this with some gentle exercise, such as short walks, which will help. If tiredness is making you feel sleepy, don’t operate or drive machinery.
Signs of an allergic reaction include skin rashes and itching, a high temperature, shivering, reddening of the face, dizziness, a headache, breathlessness, anxiety, and a feeling that you want to pass urine. You'll be monitored for any signs of an allergic reaction during the treatment. Tell your doctor or nurse about any side effects you have.
Less common side effects
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Risk of infection
Asparaginase can reduce the number of white blood cells, which help fight infection. White blood cells are produced by the bone marrow. If the number of your white blood cells is low, you'll be more prone to infections. A low white blood cell count is called neutropenia.
Neutropenia begins seven days after treatment, and your resistance to infection is usually at its lowest 10-14 days after chemotherapy. The number of your white blood cells will then increase steadily and usually return to normal before your next cycle of chemotherapy is due.
Contact your doctor or the hospital straight away if:
your temperature goes above 38ºC (100.4ºF)
you suddenly feel unwell, even with a normal temperature.
You'll have a blood test before having more chemotherapy to check the number of white blood cells. Occasionally, your treatment may need to be delayed if the number of your blood cells (blood count) is still low.
Bruising or bleeding
Asparaginase can reduce the production of platelets, which help the blood to clot. Tell your doctor if you have any unexplained bruising or bleeding, such as nosebleeds, bleeding gums, blood spots or rashes on the skin. You may need to have a platelet transfusion if your platelet count is low.
Asparaginase can reduce the number of red blood cells, which carry oxygen around the body. A low red blood cell count is called anaemia. This may make you feel tired and breathless. Tell your doctor or nurse if you have these symptoms. You may need to have a blood transfusion if the number of red blood cells becomes too low.
Raised blood sugar
Asparaginase may cause a temporary increase in the level of sugar in your blood. This is because it affects the production of insulin (a hormone that regulates blood sugar levels). Your blood sugar levels will be checked regularly and you may be taught how to do this yourself at home. Some signs of a raised blood sugar level are feeling thirsty, needing to pass urine more often, and feeling hungry. If you get any of these, let your doctor or nurse know.
Pain in the abdomen
Rarely, asparaginase can cause pancreatitis (swelling and tenderness of the pancreas). This causes a sharp pain in the upper part of your tummy (abdomen) and sickness. Tell your doctor straight away if you have any of these symptoms. They’ll examine you and prescribe painkillers and any other necessary treatment.
Fever and chills
These may occur from the time your treatment is given, but they don’t usually last long. Your doctor may prescribe medicines to reduce these effects.
Asparaginase can cause confusion. This is a very rare side effect and will usually go away if the drip is stopped. Tell your nurse or doctor straight away if you notice this side effect.
Asparaginase may cause drowsiness. If you feel drowsy, it’s important not to operate machinery or drive.
It’s important to let your doctor know straight away if you feel unwell or have any severe side effects, even if they’re not mentioned above.
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Pain along the vein
Asparaginase can cause pain at the place where the injection is given, or along the vein. If you feel pain, tell your nurse or doctor straight away so that they can check the site. They may give the drug more slowly or flush it through with more fluid to reduce pain.
Risk of developing a blood clot
Cancer can increase the risk of developing a blood clot (thrombosis), and chemotherapy may increase this risk further.
A blood clot may cause symptoms such as pain, redness and swelling in a leg, or breathlessness and chest pain. Blood clots can be very serious, so it’s important to tell your doctor straight away if you notice any of these symptoms. Most clots can be treated with drugs that thin the blood. The doctor or nurse can give you more information.
Some medicines, including those that you can buy in a shop or chemist, can be harmful to take when you're having chemotherapy. Tell your doctor about any medicines you're taking, including over-the-counter drugs, complementary therapies and herbal drugs.
Your ability to become pregnant or father a child may be affected by having this treatment. It's important to discuss fertility with your doctor before starting treatment.
It's not advisable to become pregnant or father a child while having asparaginase, as it may harm the developing baby. It’s important to use effective contraception while having this drug and for at least a few months afterwards. You can discuss this with your doctor.
It’s not known whether chemotherapy drugs can be present in semen or vaginal fluids. To protect your partner, it’s safest to either avoid sex or use a barrier form of contraception for about 48 hours after chemotherapy.
There's a potential risk that chemotherapy drugs may be present in breast milk. Women are advised not to breastfeed during chemotherapy, and for a few months afterwards.
If you’re admitted to hospital for a reason not related to the cancer, it’s important to tell the doctors and nurses looking after you that you're having chemotherapy treatment. You should tell them the name of your cancer specialist so that they can ask for advice.
It’s a good idea to know who you should contact if you have any problems or troublesome side effects when you’re at home. Your chemotherapy nurse or doctor will give you details of who to contact for advice. This should include ‘out-of hours’ contact details if you need to call someone at evenings, overnight or at the weekend.
This section is based on our Crisantaspase factsheet which has been compiled using information from a number of reliable sources, including: