Onkológia 3/2026

Clinical use of pegylated asparaginase in the treatment of acute lymphoblastic leukemia

Acute lymphoblastic leukemia (ALL) is an aggressive hematological malignancy whose prognosis in adult patients has improved significantly over the past two decades thanks to the introduction of pediatric-inspired treatment protocols. A key component of these regimens is L-asparaginase—an enzyme that induces depletion of asparagine, an amino acid essential for the survival of leukemic blasts, thereby selectively inhibiting their proliferation. Pegylated asparaginase (PEG-ASP) is a pegylated form of native L-asparaginase from Escherichia coli, characterized by a prolonged half-life, allowing for less frequent administration (every 14 days) and reduced immunogenicity compared to the native form. Despite its proven efficacy, however, the use of PEG-ASP in adults is limited by a specific spectrum of adverse effects, including hepatotoxicity, pancreatitis, coagulopathy with a risk of both thrombosis and bleeding, hyperglycemia, and hypertriglyceridemia, with their incidence and severity increasing with the patient’s age. The aim of this review article is to summarize the management of PEG-ASP adverse effects in adult patients with ALL, as effective management of adverse effects without treatment interruption influences survival outcomes.

Keywords: acute lymphoblastic leukemia, pegylated asparaginase, safety profile