Tolerability and Efficacy of a 1-Bag Pegaspargase Densensitization Protocol in Pediatric Oncology Patients

Desensitization to pegaspargase has been previously attempted in patients who have a hypersensitivity reaction to pegaspargase when Erwinia asparaginase is not an available alternative because of supply issues. Often, these desensitizations have utilized a 3-bag method to complete the infusion. Retrospective chart review was utilized to evaluate the tolerability and efficacy of a 1-bag method for pegaspargase densensitization at a single center. Pegaspargase was infused over ∼3 hours with increases to the infusion rate every 15 minutes. Fifteen pediatric patients received a total of 28 pegaspargase infusions utilizing a 1-bag method. In total, 23 of the infusions were able to be successfully completed without signs of hypersensitivity reactions. In addition, 9 of the 15 patients were able to both successfully complete all infusions during the study period and have asparaginase levels within the therapeutic range 7 to 14 days after the infusion. Four of the 5 patients that did experience a hypersensitivity reaction were able to complete the infusion, however, none of these patients had acceptable asparaginase levels postinfusion. No patient required intubation or advanced life support measures secondary to anaphylaxis. Overall, the pegaspargase method described here was successful and well tolerated in a majority of patients.