L-Asparaginase and Steroids
CSVT developed in patients receiving a combined therapy of ASP and
steroids. The most commonly used ASP product was that of the nativeE. coli (KidrolaseR; EUSA Pharma, France). CSVT rates were
observed to differ with different treatment regimens depending on the
type of ASP or steroid used. CSVT occurred in patients who received
either native L asparginase or Pegylated ASP as the predominant ASP
product, whereas none of the patients who received Erwinia-derived ASP
as the predominant ASP product developed CSVT. Furthermore, 77% of CSVT
events occurred while receiving combined ASP and dexamethasone treatment
(during Reinduction I or II or the first 20 weeks of continuation
therapy in Int/high risk patients) compared to 23% of events that
occurred during combined ASP and prednisone therapy (Induction). Of note
is that all patients treated as per our protocol received only 2 or 3
weeks of combined asparginase and Prednisone (40 mg/m2/day), whereas
they received 4 weeks of dexamethasone if they were classified as low
risk or 19 weeks of combined dexamethasone and asparginase if classified
as Int/ high risk thus resulting in more exposure to the
dexamethasone/aspa combination.