Asparaginase is an enzyme which is used to treat
acute lymphoblastic leukemia (ALL). It is marketed under the brand name
Elspar®. It can be given intramuscularly
or intravenously.

Mechanism of action

The rationale behind asparaginase is that it takes advantage
of the fact that ALL cells are unable to synthesize the non-essential
amino acid asparagine whereas normal cells are able to make their own
asparagine. These leukemic cells depend on circulating asparagine. Asparaginase
however catalyzes the conversion of L-asparagine to aspartic acid and
ammonia. This deprives the leukemic cell of circulating asparagine.

Side effects

The main side effect is an allergic or hypersensitivity reaction. Asparaginase
has also been associated with pancreatitis. Additionally, it can also
be associated with a coagulopathy as it decreases protein synthesis, including
synthesis of coagulation factors and anticoagulant factor, leading to
bleeding or thrombotic events.