Case series of desensitization to pegylated escherichia coli–derived asparaginase An effective option in response to the need
Main Article Content
Keywords
Acute Lymphoblastic Leukemia, Desensitization, Drug allergy, Hypersensitivity, Oncaspar
Abstract
Introduction: Asparaginase is an integral component in the treatment of acute lymphoblastic leukemia. The asparaginase products available in our country are Escherichia Coli (E. Coli)-derived asparaginase (Leunase), pegaspargase (Oncaspar), and, to a lesser extent, Erwinia chrysanthemi-derived asparaginase. Hypersensitivity reactions (HSR) are reported less frequently in those receiving pegaspargase, ranging from 3% to 15%; however, these reactions can limit its use in this population.
Case report: We present four patients with B-cell ALL who experienced a severe allergic HSR, anaphylaxis, leading us to perform a 12-step desensitization protocol to pegaspargase to ensure that the patients received first-line treatment for their oncologic condition. Management and outcomes: Skin tests were performed, with positive results in two out of four patients. Subsequently, a 12-step desensitization protocol was carried out. Pegaspargase was diluted with 0.9% saline solution in three bags (concentrations 1:100, 1:10, and 1:1). Infusions used four steps per bag titrated every 15 minutes up to a maximum rate of 80 mL/ hour for step 12. A successful administration of pegaspargase was achieved, and the patients continued with their ALL treatment.
References
2. Burke MJ, Zalewska-Szewczyk B. Hypersensitivity reactions to asparaginase therapy in acute lymphoblastic leukemia: immunology and clinical consequences. Future Oncol 2022;18:1285–99. https://doi.org/10.2217/fon-2021-1288.
3. van der Sluis IM, Vrooman LM, Pieters R, Baruchel A, Escherich G, Goulden N, et al. Consensus expert recommendations for identification and management of asparaginase hypersensitivity and silent inactivation. Haematologica 2016;101:279–85. https://doi.org/10.3324/haematol.2015.137380.
4. Rizzari C, Conter V, Starý J, Colombini A, Moericke A, Schrappe M. Optimizing asparaginase therapy for acute lymphoblastic leukemia. Curr Opin Oncol 2013;25 Suppl 1:S1-9. https://doi.org/10.1097/CCO.0b013e32835d7d85.
5. Pagani M, Bavbek S, Alvarez-Cuesta E, Berna Dursun A, Bonadonna P, Castells M, et al. Hypersensitivity reactions to chemotherapy: an EAACI Position Paper. Allergy 2022;77:388–403. https://doi.org/10.1111/all.15113.
6. Cui J, Jiang L, Xu B, Bai Y. L-asparaginase activity and anti-L-asparaginase antibody as biomarkers in estimating PEG-asp-related anaphylaxis risk in childhood acute lymphoblastic leukemia patients. Allergol Immunopathol (Madr) 2023;51:28–35. https://doi.org/10.15586/aei.v51i3.771.
7. Swanson HD, Panetta JC, Barker PJ, Liu Y, Inaba H, Relling MV, et al. Predicting success of desensitization after pegaspargase allergy. Blood 2020;135:71–5. https://doi.org/10.1182/blood.2019003407.
8. Broos N, Brigitha LJ, Schuurhof A, Röckmann-Helmbach H, Tissing WJE, Pieters R, et al. Safety of mRNA-based COVID-19 vaccination in paediatric patients with a PEG-asparaginase allergy. EJC Paediatr Oncol 2023;1:100002. https://doi.org/10.1016/j.ejcped.2022.100002.
9. Turgay Yagmur I, Guzelkucuk Z, Yarali N, Ozyoruk D, Toyran M, Civelek E, et al. Evaluation of hypersensitivity reactions to cancer chemotherapeutic agents in pediatric patients. Ann Allergy Asthma Immunol 2020;124:350–6. https://doi.org/10.1016/j.anai.2020.01.010.