{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T13:59:22Z","timestamp":1790171962807,"version":"4.1.0"},"reference-count":36,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"1","license":[{"start":{"date-parts":[[2026,6,1]],"date-time":"2026-06-01T00:00:00Z","timestamp":1780272000000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"abstract":"\n Background:<\/jats:title>\n Acute lymphoblastic leukemia (ALL) is a malignancy of lymphoid progenitor cells. Asparaginase-based regimens are highly effective in pediatric ALL, but concerns over toxicity have limited their use in adults. This study evaluates the incidence of adverse events following asparaginase treatment in the adult ALL population.<\/jats:p>\n <\/jats:sec>\n \n Materials and Methods:<\/jats:title>\n \n In this retrospective cohort study, we assessed drug-related adverse events among 67 adults with ALL treated with either a hyper-central vascular access device (CVAD) (\n n<\/jats:italic>\n = 34) or an asparaginase-containing regimen (\n n<\/jats:italic>\n = 33). Those under asparaginase-containing treatment were evaluated solely and divided into two groups of pegylated asparaginase (PEG-asparaginase) (\n n<\/jats:italic>\n = 21) and L-asparaginase (\n n<\/jats:italic>\n = 12). We compared the incidence of hepatotoxicity, pancreatitis, hypertriglyceridemia, hypercholesterolemia, hyperglycemia, hypersensitivity, neurological disorders, and thrombotic events.\n <\/jats:p>\n <\/jats:sec>\n \n Results:<\/jats:title>\n \n Age-adjusted analysis showed the risk of thrombosis was significantly higher in the asparaginase group compared to hyper-CVAD (odds ratio [OR] = 17.9, 95% confidence interval [CI]: 1.69\u20132512,\n P<\/jats:italic>\n = 0.012). In contrast, risks of fungal infection (OR = 0.081, 95% CI: 0.0006\u20130.83,\n P<\/jats:italic>\n = 0.032) and neutropenic fever (OR = 0.0006, 95% CI: 2.8e-17\u20130.010,\n P<\/jats:italic>\n < 0.0001) were significantly lower. A sub-analysis revealed the elevated thrombosis risk was specific to PEG-asparaginase versus hyper-CVAD (OR = 47.05, 95% CI: 3.83\u20136905,\n P<\/jats:italic>\n = 0.001), not L-asparaginase (\n P<\/jats:italic>\n = 0.55). Neutropenic fever risk was lower for both L-asparaginase (OR = 0.0015,\n P<\/jats:italic>\n < 0.0001) and PEG-asparaginase (OR = 0.0011,\n P<\/jats:italic>\n < 0.0001).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion:<\/jats:title>\n Asparaginase use in adults with ALL was associated with fewer overall adverse events, specifically lower infection risks, compared to hyper-CVAD. However, it significantly increased the risk of thrombosis, an effect driven primarily by the PEG-asparaginase formulation. While L-asparaginase appeared more favorable, the small sample size limits generalizability. These findings indicate that asparaginase remains a viable option for adults, but requires vigilant monitoring and prophylaxis for thrombotic events.<\/jats:p>\n <\/jats:sec>","DOI":"10.4103\/jrms.jrms_748_25","type":"journal-article","created":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T13:00:38Z","timestamp":1790168438000},"update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["Asperginase-based chemotherapy regimen for acute lymphoblastic leukemia: A cohort study with promising outcomes on adults"],"prefix":"10.4103","volume":"31","author":[{"given":"Padideh","family":"Oghab","sequence":"first","affiliation":[{"name":"Department of Hematology-Oncology, Isfahan University of Medical Sciences, Isfahan, Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masoomeh","family":"Bakhshi","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Isfahan University of Medical Sciences, Isfahan, Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohadese","family":"Pourpoune","sequence":"additional","affiliation":[{"name":"Department of Hematology-Oncology, Isfahan University of Medical Sciences, Isfahan, Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Narges","family":"Motamedi","sequence":"additional","affiliation":[{"name":"Department of Community and Family Medicine, Isfahan University of Medical Sciences, Isfahan, Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2026,6]]},"reference":[{"key":"R1-20260923","doi-asserted-by":"crossref","first-page":"650","DOI":"10.1002\/ajh.26156","article-title":"Acute lymphoblastic leukemia: A population-based study of outcome in the United States based on the surveillance, epidemiology, and end results (SEER) database, 1980-2017","volume":"96","author":"Sasaki","year":"2021","journal-title":"Am J Hematol"},{"key":"R2-20260923","doi-asserted-by":"crossref","first-page":"100908","DOI":"10.1016\/j.blre.2021.100908","article-title":"Optimizing use of L-asparaginase-based treatment of adults with acute lymphoblastic leukemia","volume":"53","author":"Douer","year":"2022","journal-title":"Blood Rev"},{"key":"R3-20260923","doi-asserted-by":"crossref","first-page":"725","DOI":"10.1001\/jamaoncol.2017.5305","article-title":"Pediatric-inspired treatment regimens for adolescents and young adults with philadelphia chromosome-negative acute lymphoblastic leukemia: A review","volume":"4","author":"Siegel","year":"2018","journal-title":"JAMA Oncol"},{"key":"R4-20260923","doi-asserted-by":"crossref","first-page":"1548","DOI":"10.1182\/blood-2018-10-881961","article-title":"A pediatric regimen for older adolescents and young adults with acute lymphoblastic leukemia: Results of CALGB 10403","volume":"133","author":"Stock","year":"2019","journal-title":"Blood"},{"key":"R5-20260923","doi-asserted-by":"crossref","first-page":"153","DOI":"10.3109\/10428199309149129","article-title":"L-asparaginase and PEG asparaginase \u2013 Past, present, and future","volume":"10","author":"Keating","year":"1993","journal-title":"Leuk Lymphoma"},{"key":"R6-20260923","doi-asserted-by":"crossref","first-page":"1","DOI":"10.3389\/fmicb.2024.1269282","article-title":"Desirable L-asparaginases for treating cancer and current research trends","volume":"15","author":"Tsegaye","year":"2024","journal-title":"Front Microbiol"},{"key":"R7-20260923","doi-asserted-by":"crossref","first-page":"987","DOI":"10.1182\/blood.2019002132","article-title":"How I treat the toxicities of pegasparaginase in adults with acute lymphoblastic leukemia","volume":"135","author":"Aldoss","year":"2020","journal-title":"Blood"},{"key":"R8-20260923","doi-asserted-by":"crossref","first-page":"S82","DOI":"10.1016\/S2152-2650(21)01221-0","article-title":"Hyper-CVAD in 2021: Lessons learned and new approaches","volume":"21","author":"Jabbour","year":"2021","journal-title":"Clin Lymphoma Myeloma Leuk"},{"key":"R9-20260923","doi-asserted-by":"crossref","first-page":"2039","DOI":"10.1038\/sj.leu.2400861","article-title":"The hyper-CVAD regimen improves outcome in relapsed acute lymphoblastic leukemia","volume":"11","author":"Koller","year":"1997","journal-title":"Leukemia"},{"key":"R11-20260923","doi-asserted-by":"crossref","first-page":"375","DOI":"10.1111\/ejh.12600","article-title":"Toxicity profile of repeated doses of PEG-asparaginase incorporated into a pediatric-type regimen for adult acute lymphoblastic leukemia","volume":"96","author":"Aldoss","year":"2016","journal-title":"Eur J Haematol"},{"key":"R12-20260923","article-title":"Common terminology criteria for adverse events","author":"Health","year":"2017","journal-title":"Version 5.0, U.S. Department of health and human services"},{"key":"R13-20260923","doi-asserted-by":"crossref","first-page":"67","DOI":"10.2174\/1573403X14666180123165542","article-title":"Hypertriglyceridemia \u2013 Common causes, prevention and treatment strategies","volume":"14","author":"Rygiel","year":"2018","journal-title":"Curr Cardiol Rev"},{"key":"R15-20260923","doi-asserted-by":"crossref","first-page":"36","DOI":"10.1097\/01.NAJ.0000931888.96896.a1","article-title":"CE: Febrile neutropenia in the chemotherapy patient","volume":"123","author":"Foley","year":"2023","journal-title":"Am J Nurs"},{"key":"R16-20260923","first-page":"85","article-title":"Acute kidney injury: Definition, pathophysiology and clinical phenotypes","volume":"37","author":"Makris","year":"2016","journal-title":"Clin Biochem Rev"},{"key":"R17-20260923","first-page":"55","article-title":"Asparaginase in the treatment of acute lymphoblastic leukemia in adults: Current evidence and place in therapy","volume":"12","author":"Juluri","year":"2022","journal-title":"Blood Lymphat Cancer"},{"key":"R18-20260923","doi-asserted-by":"crossref","first-page":"526","DOI":"10.1038\/leu.2014.229","article-title":"Long-term outcome of a pediatric-inspired regimen used for adults aged 18-50 years with newly diagnosed acute lymphoblastic leukemia","volume":"29","author":"DeAngelo","year":"2015","journal-title":"Leukemia"},{"key":"R19-20260923","doi-asserted-by":"crossref","first-page":"66","DOI":"10.21147\/j.issn.1000-9604.2017.01.08","article-title":"PEG-asparaginase in BFM-90 regimen improves outcomes in adults with newly diagnosed lymphoblastic lymphoma","volume":"29","author":"Zheng","year":"2017","journal-title":"Chin J Cancer Res"},{"key":"R20-20260923","doi-asserted-by":"crossref","first-page":"606","DOI":"10.1038\/leu.2017.265","article-title":"Results of NOPHO ALL2008 treatment for patients aged 1-45 years with acute lymphoblastic leukemia","volume":"32","author":"Toft","year":"2018","journal-title":"Leukemia"},{"key":"R21-20260923","doi-asserted-by":"crossref","first-page":"2475","DOI":"10.1182\/blood-2018-01-827949","article-title":"Thromboembolism in acute lymphoblastic leukemia: Results of NOPHO ALL2008 protocol treatment in patients aged 1 to 45 years","volume":"131","author":"Rank","year":"2018","journal-title":"Blood"},{"key":"R22-20260923","doi-asserted-by":"crossref","first-page":"452","DOI":"10.1111\/j.1365-2141.2010.08524.x","article-title":"The frequency and management of asparaginase-related thrombosis in paediatric and adult patients with acute lymphoblastic leukaemia treated on Dana-Farber Cancer Institute consortium protocols","volume":"152","author":"Grace","year":"2011","journal-title":"Br J Haematol"},{"key":"R23-20260923","first-page":"328","article-title":"Thromboembolism prophylaxis in adult patients with acute lymphoblastic leukemia treated in the GRAALL-2005 study","volume":"136","author":"Orvain","year":"2020","journal-title":"Blood"},{"key":"R24-20260923","doi-asserted-by":"crossref","first-page":"264","DOI":"10.1182\/blood.2020006243","article-title":"Thrombosis in ALL: A risk without clear mitigation","volume":"136","author":"Stock","year":"2020","journal-title":"Blood"},{"key":"R25-20260923","doi-asserted-by":"crossref","first-page":"2514","DOI":"10.1200\/JCO.2017.76.8192","article-title":"Intensified therapy of acute lymphoblastic leukemia in adults: Report of the randomized GRAALL-2005 clinical trial","volume":"36","author":"Huguet","year":"2018","journal-title":"J Clin Oncol"},{"key":"R26-20260923","doi-asserted-by":"crossref","first-page":"58","DOI":"10.1038\/leu.2016.219","article-title":"Pegylated-asparaginase during induction therapy for adult acute lymphoblastic leukaemia: Toxicity data from the UKALL14 trial","volume":"31","author":"Patel","year":"2017","journal-title":"Leukemia"},{"key":"R27-20260923","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1080\/16078454.2024.2329027","article-title":"Outcomes and adverse events in older acute lymphoblastic Leukemia patients treated with a pediatric-inspired protocol with pegylated or native asparaginase","volume":"29","author":"Perusini","year":"2024","journal-title":"Hematology"},{"key":"R28-20260923","doi-asserted-by":"crossref","first-page":"1033","DOI":"10.1080\/10428194.2017.1354372","article-title":"Advances in adult acute lymphoblastic leukemia therapy","volume":"59","author":"Aldoss","year":"2018","journal-title":"Leuk Lymphoma"},{"key":"R29-20260923","doi-asserted-by":"crossref","first-page":"5515","DOI":"10.3390\/ijms23105515","article-title":"Neurotoxicity associated with treatment of acute lymphoblastic leukemia chemotherapy and immunotherapy","volume":"23","author":"\u015aliwa-Tytko","year":"2022","journal-title":"Int J Mol Sci"},{"key":"R30-20260923","doi-asserted-by":"crossref","first-page":"862","DOI":"10.4236\/ojped.2023.136094","article-title":"Transient diabetes induced by L-asparaginase","volume":"13","author":"Diop","year":"2023","journal-title":"Open J Pediatr"},{"key":"R31-20260923","doi-asserted-by":"crossref","first-page":"176","DOI":"10.1080\/10428194.2020.1824068","article-title":"Tolerability and toxicity of pegaspargase in adults 40 years and older with acute lymphoblastic leukemia","volume":"62","author":"Daley","year":"2021","journal-title":"Leuk Lymphoma"},{"key":"R32-20260923","doi-asserted-by":"crossref","first-page":"e000858","DOI":"10.1136\/esmoopen-2020-000858","article-title":"Managing toxicities with asparaginase-based therapies in adult ALL: Summary of an ESMO open-cancer horizons roundtable discussion","volume":"5","author":"Burke","year":"2020","journal-title":"ESMO Open"},{"key":"R33-20260923","doi-asserted-by":"crossref","first-page":"e28040","DOI":"10.1002\/pbc.28040","article-title":"Asparaginase formulation impacts hypertriglyceridemia during therapy for acute lymphoblastic leukemia","volume":"67","author":"Finch","year":"2020","journal-title":"Pediatr Blood Cancer"},{"key":"R34-20260923","first-page":"1","article-title":"Prognostic factors and outcome of patients with adult acute lymphoblastic leukemia treated with the hyper-CVAD regimen: A retrospective study","author":"Malakoutikhah","year":"2023","journal-title":"Adv Hematol 2023"},{"key":"R35-20260923","first-page":"60","article-title":"The side effects and clinical efficacy of pegaspargase and E. coli L-asparaginase in the treatment of childhood acute lymphoblastic leukemia","volume":"8","author":"Xie","year":"2013","journal-title":"Natl Med Front China"},{"key":"R36-20260923","first-page":"1028","article-title":"Clinical comparison of permenthase and E. coli L-Asparaginase in the treatment of acute lymphoblastic leukemia in children","volume":"28","author":"Li","year":"2019","journal-title":"Chin J Convalescent Med"},{"key":"R37-20260923","first-page":"58","article-title":"Comparison of efficacy of pegaspargase and E. coli L-asparaginase in the treatment of children with acute lymphoblastic leukemia","volume":"27","author":"Shi","year":"2019","journal-title":"Clin Res"},{"key":"R38-20260923","doi-asserted-by":"crossref","first-page":"244","DOI":"10.21037\/tp-20-178","article-title":"Efficacy and safety of PEG-asparaginase versus E. coli L-asparaginase in Chinese children with acute lymphoblastic leukemia: A meta-analysis","volume":"10","author":"Dai","year":"2021","journal-title":"Transl Pediatr"}],"container-title":["Journal of Research in Medical Sciences"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.4103\/jrms.jrms_748_25","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T13:00:43Z","timestamp":1790168443000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.4103\/jrms.jrms_748_25"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6]]},"references-count":36,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026]]}},"URL":"https:\/\/doi.org\/10.4103\/jrms.jrms_748_25","relation":{},"ISSN":["1735-1995","1735-7136"],"issn-type":[{"value":"1735-1995","type":"print"},{"value":"1735-7136","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6]]},"assertion":[{"value":"2025-07-13","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-06-29","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}