# Asparaginase (pegaspargase, calaspargase pegol, Erwinia asparaginase)

Source: https://onco.cc/drugs/asparaginase/  
OnCo record `asparaginase` (Treatment). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

An enzyme that starves leukaemia cells of an amino acid they cannot make; a mainstay of childhood ALL therapy for 50 years, with new versions solving allergy and supply problems.

## Summary

E. coli asparaginase (1978), pegaspargase (1994; first-line 2006), calaspargase pegol (2018, longer interval) and recombinant Erwinia asparaginase (Rylaze, 2021) after Erwinaze shortages. Asparaginase intensity underlies paediatric-inspired adult ALL regimens. Toxicities: hypersensitivity, pancreatitis, thrombosis, hepatotoxicity, hyperglycaemia; silent inactivation is monitored by asparaginase activity levels.

## Fields

- Kind: Treatment
- Status: approved
- Last checked: 2026-09-08
- Tags: gap-fill
- Brand: Oncaspar / Asparlas / Rylaze / Erwinaze
- Modality: Enzyme therapy
- Mechanism: Depletes plasma asparagine (and glutamine), starving lymphoblasts that lack asparagine synthetase; pegylation extends half-life, Erwinia-derived enzyme avoids cross-reactive hypersensitivity.
- Approvals: US 1994: ALL (pegaspargase, hypersensitivity to native); first line 2006; US 2018: ALL in patients 1 month-21 years (calaspargase pegol); US 2021: ALL/LBL with hypersensitivity to E. coli asparaginase (Rylaze); EU 2016: Oncaspar centralised 2016; Erwinase and native asparaginases national

## Sources

- Wikipedia: https://en.wikipedia.org/wiki/Asparaginase
- Label: Rylaze (DailyMed): https://dailymed.nlm.nih.gov/dailymed/search.cfm?labeltype=all&query=Rylaze

## Connected records

- cancers: [Acute lymphoblastic leukaemia](https://onco.cc/cancers/all-leukemia/), [Adolescent and young adult cancers (ages 15 to 39)](https://onco.cc/cancers/aya-cancers/), [Extranodal NK/T-cell lymphoma](https://onco.cc/cancers/extranodal-nk-t-cell-lymphoma/), [High-risk acute lymphoblastic leukaemia in children (high-risk B-ALL and T-ALL)](https://onco.cc/cancers/all-paediatric-high-risk/), [Infant acute lymphoblastic leukaemia (KMT2A-rearranged, under one year)](https://onco.cc/cancers/all-infant/), [Peripheral T-cell lymphomas (including cutaneous T-cell lymphoma)](https://onco.cc/cancers/peripheral-t-cell-lymphoma/), [Philadelphia chromosome-positive acute lymphoblastic leukaemia in children (Ph-positive ALL)](https://onco.cc/cancers/all-paediatric-ph-positive/), [Relapsed and refractory acute lymphoblastic leukaemia in children](https://onco.cc/cancers/all-paediatric-relapsed/), [Standard-risk B-cell acute lymphoblastic leukaemia in children](https://onco.cc/cancers/all-paediatric-standard-risk/)
- technologies: [Cytotoxic chemotherapy](https://onco.cc/technologies/cytotoxic-chemotherapy/)
- companies: [Jazz Pharmaceuticals](https://onco.cc/companies/jazz/), [Servier](https://onco.cc/companies/servier/)
- terms: [The lymphoma regimen alphabet: R-CHOP, pola-R-CHP, DA-EPOCH-R, ABVD, BEACOPP and the rest](https://onco.cc/terms/lymphoma-tx-regimen-alphabet/)
- trials: [A Study to Compare Standard Chemotherapy to Therapy With CPX-351 and/or Gilteritinib for Patients With Newly Diagnosed AML With or Without FLT3 Mutations](https://onco.cc/trials/nct04293562/), [AALL0232](https://onco.cc/trials/aall0232/), [AALL1231](https://onco.cc/trials/aall1231/), [ALL R3 (UKALLR3)](https://onco.cc/trials/ukallr3/), [Combination Chemotherapy in Treating Young Patients With Newly Diagnosed High-Risk B Acute Lymphoblastic Leukemia and Ph-Like TKI Sensitive Mutations](https://onco.cc/trials/nct02883049/), [Combination Chemotherapy With or Without Bone Marrow Transplantation in Treating Children With Acute Myeloid Leukemia](https://onco.cc/trials/nct00003436/), [Combination Chemotherapy With or Without Lestaurtinib in Treating Younger Patients With Newly Diagnosed Acute Lymphoblastic Leukemia](https://onco.cc/trials/nct00557193/), [Response-Based Chemotherapy in Treating Newly Diagnosed Acute Myeloid Leukemia or Myelodysplastic Syndrome in Younger Patients With Down Syndrome](https://onco.cc/trials/nct02521493/), [SMILE](https://onco.cc/trials/smile-enktl/), [Therapy for Pediatric Relapsed or Refractory Precursor B-Cell Acute Lymphoblastic Leukemia and Lymphoma](https://onco.cc/trials/nct01700946/)
- key papers: [Phase II study of SMILE chemotherapy for newly diagnosed stage IV, relapsed, or refractory extranodal natural killer (NK)/T-cell lymphoma, nasal type: the NK-Cell Tumor Study Group study](https://onco.cc/key-papers/paper-smile-chemotherapy-nk-t-cell-lymphoma-jco-2011/)
- roadmaps: [Lymphoma roadmap: from a jaw tumour in Uganda and the first human cancer virus to gene-expression subtypes, PET-adapted chemotherapy, CAR-T cells, bispecific antibodies and the genetics-directed trials now recruiting](https://onco.cc/roadmaps/lymphoma-roadmap/), [Paediatric oncology roadmap: cooperative-group cures → engineered immunity → drugs developed for children first](https://onco.cc/roadmaps/paediatric-oncology-roadmap/)
- ideas: [Randomised evidence for the T-cell lymphomas, including the ones that are not in Europe or North America](https://onco.cc/ideas/lymphoma-ev-randomised-evidence-for-the-t-cell-lymphomas/), [The drugs that cure lymphoma, and the places that do not have them](https://onco.cc/ideas/lymphoma-ev-the-drugs-that-cure-and-the-places-without-them/)
- pathways: [Glutamine addiction](https://onco.cc/pathways/glutamine-metabolism/)
- drugs: [Crisantaspase (recombinant Erwinia asparaginase)](https://onco.cc/drugs/crisantaspase/)

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