Alternative algorithm for L-asparaginase allergy in children with acute lymphoblastic leukemia

Area of Science:

• Oncology
• Pharmacology
• Allergy and Immunology

Background:

• L-asparaginase is a vital chemotherapy for acute lymphoblastic leukemia.
• Alternative L-asparaginase formulations are scarce globally, particularly in Turkey.

Purpose of the Study:

• To assess the effectiveness of premedication and desensitization protocols for managing hypersensitivity reactions to Escherichia coli-asparaginase in pediatric acute lymphoblastic leukemia patients.
• To enable continued chemotherapy in patients experiencing hypersensitivity reactions when alternative treatments are not accessible.

Main Methods:

• A prospective study involving pediatric patients with acute lymphoblastic leukemia who developed systemic hypersensitivity reactions to E. coli-asparaginase.
• Patients received either premedication, desensitization, or a combination of both, based on reaction severity.
• Polyethylene glycol-asparaginase was used when available.

Main Results:

• Nineteen patients experienced hypersensitivity reactions to E. coli-asparaginase over four years.
• Of 16 patients with anaphylaxis, 7 tolerated re-treatment with E. coli-asparaginase after premedication and desensitization.
• Premedication alone allowed 5 of 8 patients with acute allergic reactions to continue treatment without recurrence.
• Polyethylene glycol-asparaginase was successfully administered to the 3 patients for whom it was available.

Conclusions:

• E. coli-asparaginase re-administration was successful in over half of patients with prior hypersensitivity reactions, enabling completion of planned chemotherapy.
• The described approach of premedication and desensitization is a viable strategy in resource-limited settings with limited access to alternative asparaginase formulations.