Crisantaspase is a chemotherapy drug used for some types of cancer. It is also sometimes known as asparaginase. It is most commonly used to treat acute lymphoblastic leukaemia, but may sometimes be used for other types of cancer. This information describes crisantaspase, how it is given and some of its possible side effects. It should ideally be read with our general information about chemotherapy and about your type of leukaemia or cancer.

If you have any further questions you can ask your doctor or nurse at the hospital where you are having your treatment, or speak to one of our cancer support service nurses.

Crisantaspase is a colourless fluid.

Crisantaspase is given:

• by injection into a vein (intravenously) through a fine tube (cannula) inserted into the vein. It may be given through a central line that is inserted under the skin into a vein near the collarbone, or into a PICC line which is inserted into a vein in the crook of the arm.
• as a drip (infusion) through a cannula
• by injection into a muscle (intramuscular injection)
• by injection under the skin (subcutaneous injection).

Chemotherapy is usually given as a course of several sessions (or cycles) of treatment over a few months. The length of your treatment and the number of cycles you have will depend on the type of cancer for which you are being treated. Your nurse or doctor will discuss your treatment plan with you.

Each person's reaction to chemotherapy is different. Some people have very few side effects, while others may experience more. The side effects described in this information will not affect everyone who is given crisantaspase, and may be different if you are having more than one chemotherapy drug.

We have outlined the most common side effects and some of the less common ones, so that you can be aware of them if they occur. However, we have not included those which are very rare and therefore extremely unlikely to affect you. If you do notice any effects which you think may be due to the drug but which are not listed in this information, please discuss them with your doctor or chemotherapy nurse.

Feeling sick (nausea) and being sick (vomiting) If sickness does occur it may begin a few hours after the treatment is given and last for a few days. Your doctor can prescribe very effective anti-sickness (anti-emetic) drugs to prevent, or greatly reduce, nausea and vomiting. If the sickness is not controlled, or continues, tell your doctor, who can prescribe other anti-sickness drugs which may be more effective.

Some anti-sickness drugs can cause constipation. Let your doctor or nurse know if this is a problem.

Loss of appetite A dietitian or specialist nurse at your hospital can give advice and tips on boosting appetite, coping with eating difficulties and maintaining weight.

Changes in blood clotting The liver produces particular proteins (or factors) which affect blood clotting. Crisantaspase causes either more or fewer blood-clotting factors to be produced. If fewer blood-clotting factors are produced there may be a slight chance of more bleeding or bruising than usual, although this is not common. Tell your doctor if you notice any bleeding or bruising.

If too many clotting factors are produced there may be a risk of blood clots (thrombosis). Tell your doctor as soon as possible if you have any pain, heat, redness or swelling in a limb, as these could be signs of a blood clot. Also let your doctor know about any headache, nosebleed, dizziness or feelings of confusion.

Your liver may be temporarily affected Crisantaspase may cause changes in the way that your liver works, although your liver will return to normal when the treatment is finished. It is very unlikely to cause you any harm, but your doctor will monitor this carefully. Samples of your blood will be taken from time to time to check your liver function.

Tiredness feeling weak You may feel very tired. It is important to allow yourself plenty of time to rest.

Allergic reaction Signs of an allergic reaction include skin rashes and itching, a high temperature, shivering, redness of the face, a feeling of dizziness, headache, breathlessness, anxiety and a need to pass urine. You will be monitored for any signs of an allergic reaction during the treatment.

Tell your doctor or nurse if you have any of these symptoms, as medicines can be given to counteract the allergic reaction.

Lowered resistance to infection Crisantaspase can reduce the production of white blood cells by the bone marrow, making you more prone to infection. This effect can begin seven days after treatment has been given, and your resistance to infection usually reaches its lowest point 10–14 days after chemotherapy. Your blood cells will then increase steadily, and will usually have returned to normal levels before your next course of chemotherapy is due.

Contact your doctor or the hospital straightaway if:

• your temperature goes above 38ºC (100.5ºF)
• you suddenly feel unwell (even with a normal temperature).

You will have a blood test before having more chemotherapy, to make sure that your cells have recovered. Occasionally it may be necessary to delay your treatment if the number of blood cells (the blood count) is still low.

Bruising or bleeding Crisantaspase can reduce the production of platelets (which help the blood to clot). Let your doctor know if you have any unexplained bruising or bleeding, such as nosebleeds, blood spots or rashes on the skin, or bleeding gums.

Anaemia (low number of red blood cells) While having treatment with crisantaspase you may become anaemic. This may make you feel tired and breathless. Let your doctor or nurse know if you develop these symptoms.

Increase in blood sugar Crisantaspase may cause a temporary increase in the level of sugar in your blood. This is caused by its effect on the production of insulin by the pancreas. Insulin is a hormone that regulates the levels of sugar in the blood. Your blood-sugar levels will be checked by regular blood tests, and you may be taught how to test your own levels at home. Some signs of a raised blood-sugar level are tiredness, feeling thirsty, needing to pass urine more often and an increased appetite. If you have any of these signs let your doctor or nurse know.

Pain in the abdomen Very rarely, inflammation of the pancreas occurs. This would cause a sharp pain in the upper part of your abdomen. Tell your doctor about any pain so that appropriate medicine can be prescribed.

Fever and chills These may occur from the time that the drug is given, but they do not usually last long. Your doctor may prescribe medicines such as paracetamol to reduce this side effect.

A feeling of having no energy (lethargy), sleepiness and confusion These are very rare. If you notice any of these effects it is important to tell your doctor.

Sometimes people may feel an ache along the vein when the drug is being given.

Risk of blood clots Cancer can increase your risk of developing a blood clot (thrombosis), and having chemotherapy may increase this risk further. A blood clot may cause symptoms such as pain, redness and swelling in a leg, or breathlessness and chest pain. Blood clots can be very serious so it is important to tell your doctor straightaway if you have any of these symptoms. However, most clots can usually be successfully treated with drugs to thin the blood. Your doctor or nurse can give you more information.

Other medicines Some other medicines can be harmful to take when you are having chemotherapy. Let your doctor know about any medications you are taking, including non-prescribed drugs such as complementary therapies and herbal drugs.

Fertility Your ability to become pregnant or father a child may be affected by taking this drug. It is important to discuss fertility with your doctor before starting treatment.

Contraception It is not advisable to become pregnant or father a child while taking crisantaspase as the developing foetus may be harmed. It is necessary to use effective contraception while taking this drug, and for at least a few months afterwards. Again, discuss this with your doctor.

This section is based on our Crisantaspase factsheet which has been compiled using information from a number of reliable sources, including:

• Martindale: The Complete Drug Reference (35th edition). Eds. Sweetman et al. Pharmaceutical Press, 2007.
• British National Formulary (54th edition). British Medical Association and Royal Pharmaceutical Society of Great Britain, September 2007.
• The Medicines.org.uk website - www.medicines.org.uk (November 2007).
• The Chemotherapy Source Book (3rd edition). Ed. Perry. Lippincott, Williams and Wilkins, 2001.

For further references, please see general bibliography.