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Allergic Reactions With Intravenous Compared With Intramuscular Pegaspargase in Children With High-risk Acute

Tamara MacDonald1, Ketan Kulkarni, Mark Bernstein

  • 1*Department of Pharmacy ‡Division of Pediatric Hematology/Oncology, IWK Health Centre †Department of Pediatrics, Dalhousie University, Halifax, NS, Canada.

Journal of Pediatric Hematology/Oncology
|March 2, 2016
PubMed

Insights

Intravenous pegaspargase in high-risk acute lymphoblastic leukemia (ALL) patients may increase allergic reactions. Switching to intramuscular erwinia asparaginase, though costly, might be reconsidered for safety.

Area of Science:

  • Pediatric Oncology
  • Hematology
  • Clinical Pharmacology

Background:

  • Intravenous (IV) pegaspargase is used for acute lymphoblastic leukemia (ALL).
  • Concerns exist regarding increased allergic reactions with IV pegaspargase, potentially necessitating a switch to intramuscular (IM) erwinia asparaginase.
  • High-risk (HR)-ALL patients may be particularly susceptible to these reactions.

Purpose of the Study:

  • To evaluate the incidence of allergic reactions associated with IV versus IM pegaspargase in pediatric ALL patients.
  • To determine if specific patient subgroups, such as HR-ALL, experience a higher risk of reactions.
  • To inform decisions regarding the optimal administration route of pegaspargase in ALL treatment.

Main Methods:

  • Retrospective analysis of 128 pediatric patients with ALL.
  • Comparison of allergic reaction rates between patients receiving IV pegaspargase and IM erwinia asparaginase.
  • Subgroup analysis focusing on high-risk (HR)-ALL patients.

Main Results:

  • Allergic reactions occurred in 14% of patients receiving IV pegaspargase compared to 3% receiving IM erwinia asparaginase (P=0.029).
  • The increased risk of reactions was significantly associated with HR-ALL patients (P<0.01).
  • The study identified a higher incidence of allergic reactions with IV pegaspargase, especially in high-risk ALL patients.

Conclusions:

  • The IV route of pegaspargase administration is linked to a higher risk of allergic reactions in pediatric ALL patients, particularly those with high-risk disease.
  • The potential for decreased efficacy, reduced quality of life, and increased costs associated with switching to IM erwinia asparaginase warrants careful consideration.
  • Revisiting the use of IV pegaspargase in HR-ALL patients may be necessary to balance efficacy, safety, and treatment burden.

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