Last update Jan. 15, 2019
An enzyme obtained from Escherichia coli that breaks down plasma amino acid L-asparagine by preventing the growth of malignant leukemia cells which, unlike normal cells, cannot synthesize it.
Indicated in the treatment of acute lymphoblastic leukemia since the neonatal period.
Intravenous or intramuscular administration three times a week.
Since the last update we have not found published data on its excretion in breastmilk.
Its high molecular weight makes excretion in breastmilk very unlikely. Its low oral bioavailability hinders transfer to infant plasma from breastmilk since, due to its protein nature, it degrades in the gastrointestinal tract, and is not absorbed, except in premature babies and the immediate neonatal period when there may be greater intestinal permeability.
Pharmacokinetics show that after 3 elimination half-lives (T½) 87.5% of the drug is eliminated from the body; after 4 T½ it is 94%, after 5 T½, 96.9%, after 6 T½, 98.4% and after 7 T½ it is 99%. From 7 T½ the plasma concentrations of the drug in the body are negligible. In general, a period of at least five half-lives can be considered a safe waiting period before breastfeeding again (Anderson 2016).
Assuming that it can transfer to breastmilk and taking the longest published T½ (49 hours) of all active metabolites as a reference, these 5 T½ would correspond to 10 days. Due to the major side effects, it would be advisable to wait 7 T½, which would correspond to 15 days. Meanwhile, express and discard breastmilk regularly.
The continued and long cycles make it very difficult to continue breastfeeding.
When it is possible to do so, milk detections of each patient to determine the total elimination of the drug would be the best indicator to resume breastfeeding between two cycles of chemotherapy.
During breast cancer treatment, breastfeeding must be interrupted due to potentially serious side effects for the infant. Chemotherapy does not affect milk production during or after treatment.
Abrupt weaning can be psychologically traumatic for both the mother and the infant (Pistilli 2013). If the mother wishes, the production of milk can be maintained by regularly expressing milk from the breast, being able to return to breastfeeding in the periods in which no significant traces of the drug remain in the milk (Anderson 2016) or at the end of the treatment (Pistilli 2013).
Some chemotherapeutic agents with an antibiotic effect can alter the composition of the microbiota (bacterial set or bacterial flora) of the milk and the concentration of some of its components (Urbaniak 2014). This possibly occurs temporarily with subsequent recovery, although no harmful effects are assumed or have been reported in breastfed infants.
Women undergoing chemotherapy during pregnancy have lower rates of breastfeeding due to difficulties in breastfeeding (Stopenski 2017), needing more support to achieve it.
Given the strong evidence that exists regarding the benefits of breastfeeding for the development of babies and the health of mothers, it is advisable to evaluate the risk-benefit of any maternal treatment, including chemotherapy, individually advising each mother who wishes to continue with breastfeeding (Koren 2013).
We do not have alternatives for Asparaginase.
Suggestions made at e-lactancia are done by APILAM team of health professionals, and are based on updated scientific publications. It is not intended to replace the relationship you have with your doctor but to compound it. The pharmaceutical industry contraindicates breastfeeding, mistakenly and without scientific reasons, in most of the drug data sheets.
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