Pegaspargase

INTRODUCTION

Indications

Treatment (usually with other agents) of acute lymphoblastic leukemia (ALL) in patients who have had a previous hypersensitivity reaction to native asparaginase.

Action

Consists of L-asparaginase bound to polyethylene glycol (PEG). This compound depletes asparagine, which leukemic cells cannot synthesize. Normal cells are able to produce their own asparagine and are less susceptible to the effects of asparaginase. Binding to PEG renders asparaginase less antigenic and therefore less likely to induce hypersensitivity reactions. Therapeutic Effects: Death of leukemic cells.

Adverse Reactions/Side Effects

CNS: SEIZURES, headache, malaise. GI: PANCREATITIS, abdominal pain, abnormal liver function tests, anorexia, diarrhea, lip edema, nausea, vomiting. Derm: jaundice. Endo: hyperglycemia. F and E: peripheral edema. Hemat: decreased fibrinogen disseminated intravascular coagulation, hemolytic anemia, increased thromboplastin, leukopenia, pancytopenia, thrombocytopenia. Local: injection site hypersensitivity, injection site pain, thrombosis. MS: arthralgia, myalgia, pain in extremities. Neuro: paresthesia. Misc: chills, hypersensitivity reactions, night sweats.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Be alert for new seizures or increased seizure activity, especially at the onset of drug treatment. Document the number, duration, and severity of seizures, and report these findings immediately to the physician or nursing staff.

• Watch for signs of pancreatitis, including upper abdominal pain (especially after eating), indigestion, weight loss, oily stools. Report these signs to the physician or nursing staff immediately.

• Monitor signs of hypersensitivity reactions, including pulmonary symptoms (tightness in the throat and chest, wheezing, cough, dyspnea) or skin reactions (rash, pruritus, urticaria). Notify physician or nursing staff immediately if these reactions occur.

• Report signs of blood dyscrasias, including leukopenia (fever, sore throat, signs of infection), thrombocytopenia (bruising, nose bleeds, bleeding gums), or hemolytic anemia (unusual fatigue, shortness of breath, dizziness, headache, coldness in hands and feet, pale skin, chest pain).

• Assess peripheral edema using girth measurements, volume displacement, and measurement of pitting edema (See Appendix N). Report increased swelling in feet and ankles or a sudden increase in body weight due to fluid retention.

• Be alert for signs of hyperglycemia, including confusion, drowsiness, flushed/dry skin, fruit-like breath odor, rapid/deep breathing, polyuria, loss of appetite, and unusual thirst. Patients with diabetes mellitus should check blood glucose levels frequently.

• Assess signs of paresthesia (numbness, tingling) or muscle twitching. Perform objective tests including electroneuromyography and sensory testing to document any drug-related neuropathic changes.

• Assess any joint, muscle, or extremity pain to rule out musculoskeletal pathology; that is, try to determine if pain is drug-induced rather than caused by anatomical or biomechanical problems.

• Monitor IV injection site for pain, swelling, and irritation. Report prolonged or excessive injection site reactions to the physician.

Interventions

• For patients who are medically able to begin ...