Vagrecha Anshul, Tao Vincent, Corless Rosemarie, Colon Cassandra, Redner Arlene, Atlas Mark
Department of Pediatrics, Division of Hematology/Oncology and Cellular Therapy, Cohen Children's Medical Center, New Hyde Park, NY, USA.
Department of Pediatrics, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA.
Expert Rev Clin Pharmacol. 2023 Jul-Dec;16(8):763-769. doi: 10.1080/17512433.2023.2223970. Epub 2023 Jun 15.
Pegylated form of E. coli derived asparaginase (PEG) is a crucial component of pediatric ALL therapy. Patients who develop a hypersensitivity (HSR) reaction with PEG receive an alternative form - Erwinia asparaginase (EA). However, an international shortage in 2017 had made it challenging to treat these patients. We have developed a comprehensive strategy to address this need.
This is a single center, retrospective analysis. All patients receiving PEG were premedicated to reduce infusion reactions. Patients who developed HSR underwent PEG desensitization. Patients were compared to historic controls.
Fifty-six patients were treated within the study period. There was no difference in the frequency of reactions before and after the adoption of universal premedication ( = 0.78). Eight patients (14.2%) developed either ≥ Grade 2 HSR or silent inactivation and 5 patients (62.5%) successfully underwent desensitization. The remaining three patients received EA asparaginase. This intervention led to a decrease in PEG substitution, with 3 patients (5.3%) requiring EA compared to 8 patients (15.09%) in the pre-intervention period. ( = 0.11) PEG desensitization was more cost effective than EA administration.
PEG desensitization is a safe, cost effective, and practical alternative in children with ALL and a Grade 2 or higher HSR.
大肠杆菌来源的聚乙二醇化天冬酰胺酶（PEG）是儿童急性淋巴细胞白血病（ALL）治疗的关键组成部分。对PEG发生超敏反应（HSR）的患者接受另一种形式的天冬酰胺酶——欧文氏菌天冬酰胺酶（EA）。然而，2017年的国际短缺使得治疗这些患者具有挑战性。我们制定了一项综合策略来满足这一需求。
这是一项单中心回顾性分析。所有接受PEG治疗的患者均进行了预处理以减少输液反应。发生HSR的患者接受了PEG脱敏治疗。将患者与历史对照组进行比较。
在研究期间共治疗了56例患者。采用通用预处理前后反应频率无差异（P = 0.78）。8例患者（14.2%）发生了≥2级HSR或沉默失活事件，5例患者（62.5%）成功进行了脱敏治疗。其余3例患者接受了EA天冬酰胺酶治疗。这一干预措施导致PEG替代率下降，干预后3例患者（5.3%）需要EA，而干预前为8例患者（15.09%）（P = 0.11）。PEG脱敏治疗比EA给药更具成本效益。
对于患有ALL且发生2级或更高等级HSR的儿童，PEG脱敏是一种安全、具有成本效益且实用的替代方法。
