Crisantaspase (Erwinase ®, asparaginase or L-asparaginase)
Crisantaspase is a chemotherapy drug used to treat acute lymphoblastic leukaemia (ALL). Throughout this section 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.
How asparaginase is given
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You have asparaginase in the chemotherapy day unit or during a short stay in hospital. It can be given with other chemotherapy drugs or on its own. A chemotherapy nurse will give it to you. During treatment, you usually see a cancer doctor, a chemotherapy nurse or a specialist nurse. This is who we mean when we mention doctor or nurse in this information.
Before or on the day of treatment, a nurse or person trained to take blood (phlebotomist) will take a blood sample from you. This is to check that it is okay for you to have chemotherapy.
You will also see a doctor or nurse before you have chemotherapy. They will ask you about how you have been. If your blood results are alright on the day of your treatment, the pharmacist will prepare.
Asparaginase is given by injection in one of the following ways:
into a muscle (intramuscular injection)
under the skin (subcutaneous 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).
When the chemotherapy is being given
Some people may have the following side effects while they are having the chemotherapy:
Asparaginase may cause an allergic reaction while it’s being given. Your nurse will check you for this. If you have a reaction, they will treat it quickly. Signs of a reaction can include: a rash; feeling itchy, flushed or short of breath; swelling of your face or lips; feeling dizzy; having pain in your tummy, back or chest; or feeling unwell. Tell your nurse straight away if you have any of these symptoms. Your nurse may give you drugs to help reduce the risk of a reaction.
Pain at the injection site or along the vein
If you have this, tell your nurse straight away. They will check the site. Let your nurse know if you have any pain, redness or swelling around the injection site when you go home.
Your course of chemotherapy
You have chemotherapy as a course of several sessions (or cycles) of treatment over a few months. This will depend on the treatment you have. Your doctor or nurse will tell you more about the number of cycles you are likely to have.
Possible side effects of asparaginase
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We explain the most common side effects of asparaginase here We haven’t included all the rare ones that are unlikely to affect you.
You may get some of the side effects we mention, but you are very unlikely to get all of them. If you are having other chemotherapy drugs as well, you may have some side effects that we don’t list here. Always tell your doctor or nurse about the side effects you have.
Your doctor can prescribe drugs to help control some side effects. It is very important to take them exactly as your nurse or pharmacist has explained. This means they will be more likely to work better for you. Your nurse will give you advice on managing your side effects. After your treatment is over, the side effects will start to improve.
Contact the hospital
Your nurse will give you telephone numbers for the hospital. You can call them if you feel unwell or need advice any time of day or night. Save these numbers in your phone or keep them somewhere safe.
Risk of infection
Rarely asparaginase can reduce the number of white blood cells in your blood. This will make you more likely to get an infection. When the number of white blood cells is low, it’s called neutropenia.
Contact the hospital straight away on the contact number you’ve been given if:
your temperature goes over 37.5°C (99.5°F) or over 38°C (100.4°F), depending on the advice given by your chemotherapy team
you suddenly feel unwell , even with a normal temperature
you have symptoms of an infection – this can include feeling shaky, a sore throat, a cough, diarrhoea or needing to pass urine a lot.
The number of white blood cells usually increase steadily and return to normal before your next treatment.
Bruising and bleeding
Rarely asparaginase can reduce the number of platelets in your blood. Platelets are cells that help the blood to clot. Tell your doctor if you have any bruising or bleeding you can’t explain. This includes nosebleeds, bleeding gums, blood spots or rashes on the skin.
Anaemia (low number of red blood cells)
Rarely asparaginase can reduce the number of red blood cells that carry oxygen around the body. If the number of red blood cells is low, you may be tired and breathless. Tell your doctor or nurse if you feel like this.
Swollen pancreas (pancreatitis)
Asparaginase may cause this. Tell your doctor straight away if you get sharp pain in the upper tummy (abdomen) with sickness and vomiting. They will examine your tummy, prescribe drugs to help the symptoms and give you any treatment you need.
Changes in the way the liver works
Asparaginase may affect how your liver works. This is usually mild and goes back to normal after treatment. You will have blood tests to check how well your liver is working.
The liver makes proteins that help blood to clot. Asparaginase can cause too many or too few of these proteins to be made.
Too many clotting proteins can lead to blood clots (thrombosis). A clot can cause symptoms such as pain, redness and swelling in a leg, breathlessness and chest pain. Contact your doctor straight away if you have any of these symptoms. A blood clot is serious but your doctor can treat it with drugs that thin the blood.
If not enough of these proteins 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.
Your doctor can prescribe drugs to control diarrhoea. Let them know if it is severe or if it doesn’t get better. Make sure you drink at least two litres (three and a half pints) of fluids every day if you have diarrhoea.
If you have diarrhoea more than 4–6 times in 24 hours contact the hospital on the numbers your nurse gave you.
Feeling very tired is a common side effect. It’s often worse towards the end of treatment and for some weeks after it’s finished. Try to pace yourself and get as much rest as you need. It helps to balance this with some gentle exercise, such as short walks. If you feel sleepy, don’t drive or operate machinery. You might find our information about coping with extreme tiredness (fatigue) helpful.
Asparaginase may cause headaches. If this happens, let your doctor or nurse know. They can give you painkillers.
Feeling sick or being sick
This may happen in the first few days after chemotherapy. But sickness isn’t common with asparaginase. Your doctor will prescribe anti-sickness (anti-emetic) drugs to help prevent or control sickness. Take the drugs exactly as your nurse or pharmacist explains to you. It’s easier to prevent sickness than to treat it after it has started.
Loss of appetite
You may lose your appetite during your treatment. Try to eat small meals regularly. Don’t worry if you don’t eat much for a day or two. If your appetite doesn’t improve after a few days, let your nurse or dietitian know. They can give you advice on getting more calories and protein in your diet. They may give you food supplements or meal replacement drinks to try. Your doctor can prescribe some of these and you can buy them from chemists.
Chemotherapy may affect your skin. Your doctor or nurse can tell you what to expect. If your skin feels dry, try using an unperfumed moisturising cream every day. Asparaginase can cause a rash, which may be itchy.
Always tell your doctor or nurse about any skin changes. They can give you advice and may prescribe creams or medicines to help. Any changes to your skin are usually temporary and improve when treatment finishes.
Effects on the nervous system
Asparaginase can affect the nervous system. You may feel drowsy or confused, dizzy or unsteady. Tell your doctor or nurse straight away if you notice any of these symptoms. They may make some changes to your treatment if they become problem for you. It’s important not to drive or operate machinery if you notice these effects. Rarely, this treatment can cause seizures (fits).
Less common side effects of asparaginase
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Effects on the lungs
Asparaginase can cause changes to the lungs. Always tell your doctor if you develop wheezing, a cough, fever or feel breathless. You should also let them know if any existing breathing problems get worse. If necessary, they can arrange for you to have tests to check your lungs.
Raised blood sugar
Asparaginase may raise your blood sugar levels. Your nurse will check your blood regularly for this. Symptoms of raised blood sugar include feeling thirsty, needing to pass urine more often and feeling tired. Tell your doctor or nurse if you have these symptoms.
If you have diabetes, your blood sugar levels may be higher than usual. Your doctor will talk to you about how to manage this. You may need to change your insulin or tablet dose.
It is important to tell your doctor or nurse straight away if you feel ill or have severe side effects. This includes any we don’t mention here.
Other information about asparaginase
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Some medicines can interact with chemotherapy or be harmful when you are having chemotherapy. This includes medicines you can buy in a shop or chemist. Tell your doctor about any medicines you are taking, including over-the-counter drugs, complementary therapies and herbal drugs.
Asparaginase may affect your fertility (being able to get pregnant or father a child). If you are worried about this, you can talk to your doctor or nurse before treatment starts.
Your doctor will advise you not to become pregnant or father a child during treatment. This is because the drugs may harm a developing baby. It’s important to use contraception during and for a few months after chemotherapy. You can talk to your doctor or nurse about this.
If you have sex within the first couple of days of having chemotherapy you need to use a condom. This is to protect your partner in case there is any chemotherapy in semen or vaginal fluid.
Women are advised not to breastfeed during treatment and for a few months after. This is in case there is chemotherapy in their breast milk.
Medical and dental treatment
If you need to go into hospital for any reason other than cancer, always tell the doctors and nurses that you are having chemotherapy. Give them contact details for your cancer doctor.
Talk to your cancer doctor or nurse if you think you need dental treatment. Always tell your dentist you are having chemotherapy.
This section has been compiled using a number of reliable sources, including:
electronic Medicines Compendium (eMC). medicines.org.uk (accessed July 2013).
Perry MC. The Chemotherapy Source Book. 5th edition. Lippincott, Williams and Wilkins. 2012. Scottish Medicines Consortium scottishmedicines.org.uk (accessed July 2013).
With thanks to Kelly Baillie, Senior Clinical Pharmacist, who reviewed this edition.
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