Background: Erwinia asparaginase is a chemotherapy medication for the treatment of patients with Acute Lymphoblastic Leukaemia who have previously had a hypersensitivity reaction to E. coli-derived asparaginase. There is little published information regarding the emetogenicity of erwinia asparaginase and it is not included in current international antiemetic guidelines.
Aim and Method: This study retrospectively assessed and compared the incidence of nausea and vomiting in paediatric patients receiving intravenous and intramuscular erwinia asparaginase from 2008 to 2017 in a tertiary hospital. Case notes were reviewed for the first course of erwinia asparaginase for each patient and the data collected included the dose, infusion time, concurrent chemotherapy medications, use of anti-emetics, and the incidence and severity of nausea and vomiting.
Results: Fourteen patients received erwinia asparaginase intravenously and 19 patients intramuscularly. Vomiting occurred with 1 or more doses in 57% of patients administered erwinia asparaginase intravenously compared with only 16% of patients who had intramuscular administration. More than 1 antiemetic was administered for 26% and 4% of total doses of intravenous and intramuscular erwinia asparaginase respectively. There was no correlation between nausea with or without vomiting and other chemotherapy agents administered concurrently for all patients.
Conclusions: In our cohort, nausea and vomiting was a common side effect of erwinia asparaginase with multiple antiemetics often required. Erwinia asparaginase administered intravenously had a much higher incidence of emesis than when administered intramuscularly. The incidence of vomiting in these patients suggests that erwinia asparaginase administered intravenously may be classified as at least moderately emetogenic, whereas intramuscular doses may be classified as having low emetogenic potential. These findings should be validated in other centres and/or prospectively to allow guidelines to be updated to include recommendations for antiemetics for erwinia asparaginase.