Vincristine Asparaginase

The current induction therapy for acute lymphocytic leukemia (ALL) typically consists of vincristine, asparaginase, and a steroid (prednisone or dexamethasone). An anthracycline is added for higher-risk patients. 

RH is admitted to the pediatric oncology service. She is started on allopurinol and intravenous fluids with sodium bicarbonate to prevent tumor lysis syndrome. According to her risk status, she will receive a three-drug induction with vincristine, dexamethasone, and pegylated asparaginase. She also will receive intrathecal (IT) chemotherapy for CNS prophylaxis with methotrexate, cytarabine, and hydrocortisone. 

C, cytarabine ASP, asparaginase CALCB, Cancer and Leukemia Croup B CNS, central nervous system CTX, cyclophosphamide DEX, dexamethasone DNR, daunorubicin DOX, doxorubicin IT, intrathecal captopurine MTX, methotrexate PRED, prednisone TG, thioguanine VCR, vincristine. 

L-asparaginase—be prepared to treat anaphylaxis at each administration giving with or immediately before Vincristine may increase Vincristine toxicity... 

Ronghe, M., Burke, G.A., Lowis, S.R, and Estlin, E.J. 2001. Remission induction therapy for childhood acute lymphoblastic leukaemia clinical and cellular pharmacology of vincristine, corticosteroids, L-asparaginase and anthracyclines. Cancer Treatment Reviews 27(6), 327-337. 

Anticancer Cycloserine Glucocorticoids Interferon-a L-Asparaginase Leuprolide Procarbazine Tamoxifen Vinblastine Vincristine... 

Since at presentation many patients can be quite ill with active infection and hemorrhage, the induction regimens have typically emphasized relatively myeloid-sparing cytotoxic agents. The mainstay of such therapy has been the combination of vincristine and prednisone plus asparaginase or an anthracycline, or both. These regimens achieve complete remission in 98% of children and 85% of adults. 

B. Indications and use Oncaspar is indicated for patients with ALL who require L-asparaginase in their treatment regimen but have developed hypersensitivity to the native forms of the enzyme. Oncaspar, like native L-asparaginase, is generally used in combination with other chemotherapeutic agents, such as vincristine, methotrexate, cytarabine, daunorubicin, and doxorubicin. 

Acute lymphocytic leukemia Induction vincristine plus prednisone. Remission maintenance mercaptopurine, methotrexate, and cyclophosphamide in various combinations Asparaginase, daunorubicin, carmustine, doxorubicin, cytarabine, allopurinol,1 craniospinal radiotherapy... 

J, van Eys, D, Berry, W, Crist, el al. Treatment intensity and outcome for children with acute lymphocytic leukemia of standard risk. Cancer 63 1466 (1989). si. A. Van dec Does, E, R. van Wering, 5. Sudu. et ai. Effectiveness of rubidomycin in induction therapy with vincristine, prednisone, and 1-asparaginase for standard ride childhood acute lymphocytic leukemia results of a Dutch phase HI study (ALL V). 

C. H. Pd, C M. Cheueji, 1 Weed, and C W. Jackson. Altered von Willehmiul factor molecule in children with thrombosis following asparaginase-pnedftisone-vincristine... 

Therapeutic application L-Asparaginase is used to treat childhood acute lymphocytic leukemia in combination with vincristine (see p. 390) and prednisone (see p. 393). 

VINCRISTINE CRISANTASPASE t risk of neurotoxicity if concurrently administered or if crisantaspase is administered prior to vincristine Uncertain but attributed by some to effects of asparaginase on the metabolism of vincristine Administer vincristine prior to asparaginase... 

Acute lymphocytic leukaemia (ALL) nducii on vincristine + prednisolone + asparaginase z doxorubicin CNS prophyfajeis intrathecal methotrexate with cranial irradiation z systemic high-dose methotrexate with folinic acid rescue intrathecal cytarabine intrathecal hydrocortisone / d<11 fIterance, methotrexate mercapcopurineibone marrow transplant... 

Pui CH, Jackson CW, Chesney CM, Abildgaard CF. Involvement of von Willebrand factor in thrombosis following asparaginase-prednisone-vincristine therapy for leukemia. Am J Hematol 1987 25(3) 291-8. 

Asparaginase and vincristine should not be used together on the same day, since simultaneous administration can cause increased vincristine toxicity. It has been suggested that this is due to a deleterious effect of asparaginase on hepatic function, reducing the metabolism of vincristine (5). 

Camptothecin analogs Irinotecan Topotecan Epipodophyllotoxins Etoposide Teniposide Antitumor antibiotics Bleomycin Dactinomycin Daunorubicin Doxorubicin Epirubicin Idarubicin Mitomycin Mitoxantrone Valrubicin Microtubule agents Docetaxel Paclitaxel Vinblastine Vincristine Vinorelbine Enzymes Asparaginase Pegasparaginase Metals... 

For children with ALL, induction therapy includes vincristine, a corticosteroid, and asparaginase, with or without an anthracycline. For adults with ALL, vincristine, prednisone, and an anthracycline are given, and asparaginase is sometimes added. 

C. H. Pui, C. M. Chesney, P. W. Bergum, et al. Lack of pathogenetic role of protein C and S in thrombosis associated with asparaginase-prednisone-vincristine therapy for leukemia. Br. J. Hematol. <54 283 (1985). 

Acute lymphocytic leukemia Induction vincristine plus prednisone plus asparaginase plus doxorubicin with or without cyclophosphamide. Maintenance mercaptopurine plus methotrexate... 

Four out of 14 patients with ALL given induetion chemotherapy with weekly injections of vincristine (with prednisone, daunorubicin and asparaginase) and antifungal prophylaxis with itraconazole 400 mg daily, developed severe and early vincristine-induced neurotoxicity (paraesthe-sia and muscle weakness of the hands and feet, paralytic ileus, mild laryngeal nerve paralysis). The degree and early onset of these neurotoxic reactions were unusual, and were all reversible except for mild paraesthe-sia in one patient. The complications were more serious than in a previous... 

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