Verma Anupam, Chen Karin, Bender Cynthia, Gorney Nathan, Leonard Whitney, Barnette Phillip
Department of Pediatrics, Division of Pediatric Hematology/Oncology, University of Utah, School of Medicine , Salt Lake City , Utah , USA.
Department of Pediatrics, Division of Allergy & Immunology, University of Utah, School of Medicine , Salt Lake City , Utah , USA.
Pediatr Hematol Oncol. 2019 Aug;36(5):277-286. doi: 10.1080/08880018.2019.1634778. Epub 2019 Jul 12.
Asparaginase is an important component of multi-agent chemotherapy for the treatment of pediatric acute lymphoblastic leukemia (ALL) and lymphoblastic lymphoma (LLy). Hypersensitivity to the PEGylated form, pegaspargase, is the most common toxicity observed and is ideally addressed by substituting multiple doses of erwinia asparaginase for each subsequent dose of pegaspargase. An international shortage of erwinia asparaginase has limited the therapeutic options for those experiencing pegaspargase hypersensitivity. Here, we report pegaspargase can be safely administered, while maintaining sustained levels of asparaginase activity, to patients who have had a prior hypersensitivity reaction to pegaspargase by using a standard rapid desensitization protocol. Ten patients with prior hypersensitivity reactions to pegaspargase were treated by using a standardized rapid desensitization protocol. Eight patients had therapeutic asparaginase levels between days 4 and 7 of ≥0.05 IU/mL, and seven patients continued to have sustained levels above ≥0.1 IU/mL between days 10 and 14. Based on chemotherapy regimens, five of these patients successfully received more than one dose of pegaspargase utilizing this protocol.
天冬酰胺酶是治疗儿童急性淋巴细胞白血病（ALL）和淋巴细胞淋巴瘤（LLy）的多药联合化疗的重要组成部分。对聚乙二醇化形式的培门冬酶过敏是最常见的毒性反应，理想的解决方法是用多剂欧文氏菌天冬酰胺酶替代随后的每剂培门冬酶。欧文氏菌天冬酰胺酶的国际短缺限制了对培门冬酶过敏患者的治疗选择。在此，我们报告，通过使用标准的快速脱敏方案，对培门冬酶曾有过过敏反应的患者可以安全地使用培门冬酶，同时维持天冬酰胺酶活性的持续水平。10例对培门冬酶曾有过过敏反应的患者采用标准化快速脱敏方案进行治疗。8例患者在第4至7天的治疗性天冬酰胺酶水平≥0.05 IU/mL，7例患者在第10至14天的天冬酰胺酶水平持续维持在≥0.1 IU/mL以上。根据化疗方案，其中5例患者利用该方案成功接受了一剂以上的培门冬酶治疗。
