Clinical application of asparaginase activity levels following treatment with pegaspargase

Asparaginase, an enzyme used to treat acute lymphoblastic leukemia and related forms of nonHodgkin lymphoma, depletes asparagine, which leads to lymphoblast cell death. Unlike most chemotherapeutic agents, asparaginase is a foreign protein that can result in clinical allergy and/or silent hypersensitivity with production of neutralizing antibodies that inactivate asparaginase. In North America, asparaginase activity levels can now be obtained via a commercially available assay, for therapeutic drug monitoring and investigation of potential allergic reactions. Herein, we provide recommendations and a corresponding algorithm for the clinical application of this assay after treatment with pegaspargase to evaluate suspected hypersensitivity reactions and/or silent inactivation.