A comprehensive strategy to address shortage of Erwinia asparaginase in pediatric acute lymphoblastic leukemia.
Expert Rev Clin Pharmacol
; 16(8): 763-769, 2023.
Article
em En
| MEDLINE
| ID: mdl-37294084
ABSTRACT
BACKGROUND:
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. PATIENTS ANDMETHODS:
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.RESULTS:
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 (p = 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. (p = 0.11) PEG desensitization was more cost effective than EA administration.CONCLUSION:
PEG desensitization is a safe, cost effective, and practical alternative in children with ALL and a Grade 2 or higher HSR.Palavras-chave
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Contexto em Saúde:
3_ND
Problema de saúde:
3_neglected_diseases
/
3_zoonosis
Assunto principal:
Hipersensibilidade a Drogas
/
Erwinia
/
Leucemia-Linfoma Linfoblástico de Células Precursoras
/
Antineoplásicos
Limite:
Child
/
Humans
Idioma:
En
Revista:
Expert Rev Clin Pharmacol
Ano de publicação:
2023
Tipo de documento:
Article
País de afiliação:
Estados Unidos