Asparaginase is an important chemotherapy drug for treatment of acute lymphoblastic leukemia (ALL), the most common childhood cancer. Research suggests that patients who receive more doses of the drug are more likely to survive and avoid relapse.
But asparaginase is also a major cause of a serious and life-threatening condition called acute pancreatitis. This side effect occurs in 2 to 18% of ALL patients. Currently there is no way to predict which patients are most at risk and possibly modify their treatment.
A study led by St. Jude Children’s Research Hospital has identified risk factors for asparaginase-related pancreatitis. The research included 5,398 ALL patients ranging from infants to young adults. Of these, 188 developed pancreatitis at least once during treatment. It was the largest study yet of acute pancreatitis in ALL patients.
Researchers found that teens were more likely than young children to develop acute pancreatitis. Patients who received more asparaginase for a longer period were also at greater risk. So were patients with higher levels of Native American ancestry.
The most potent risk factor scientists identified was also very uncommon. Patients with a rare variation in a gene called CPA2 had a dramatically increased risk of severe pancreatitis within weeks of receiving the drug.
“These findings, if confirmed, may help us better identify patients who are most likely to benefit from asparaginase and those who might be candidates for ALL treatment regimes that do not include the drug,” said Mary Relling, PharmD, chair of the St. Jude Department of Pharmaceutical Sciences.
The research was published in the Journal of Clinical Oncology.