Comparison of hypersensitivity reactions to PEG-asparaginase in children after intravenous and intramuscular administration.

INTRODUCTION: Polyethylene-glycolated (PEG)-asparaginase (PEG-ASP) is a crucial component of pediatric acute lymphoblastic leukemia therapy. Although hypersensitivity reactions to PEG-ASP occur less frequently than with other formulations, they are not uncommon and have an adverse impact on patient outcomes. Intravenous (IV) administration of PEG-ASP reduces patient pain and anxiety and is being used with increasing frequency in children. MATERIALS AND METHODS: A retrospective review was performed to compare the incidence of hypersensitivity reactions to PEG-ASP in children when administered either by intramuscular (IM) or IV routes between January 2006 and May 2008. RESULTS: Of 68 patients studied, 7 experienced a hypersensitivity reaction (10.3%). Two of 16 patients (12.5%) who received only IV PEG-ASP and 3 of 27 patients (11.1%) exposed to only IM PEG-ASP experienced a hypersensitivity reaction. Severe reactions (grade 3 or 4) occurred only once after 119 total doses (0.8%) of IV PEG-ASP and once after 215 total doses (0.5%) of IM PEG-ASP (P=1.0). Thrombosis or pancreatitis were rare and were not increased after IV PEG-ASP administration. DISCUSSION: IV PEG-ASP is well tolerated and does not result in a significant increase in the incidence of hypersensitivity reactions in children.

Assessment of the Role of the Pediatric Nurse in Patient Education and Follow-up of Patients Receiving Oral Anticancer Treatment.

Objective: To assess the role of the pediatric nurse/advanced practice provider in patient education and follow-up of patients receiving oral anticancer therapy. Methods: Association of Pediatric Hematology/Oncology Nurses members were invited to participate in a survey that focused on the nurses' roles in patient education of patients taking oral oncolytic agents. Data were collected via a 16-item questionnaire. Respondents included 197 nurses and advanced practice providers. Content analysis techniques were used to describe the qualitative data while Fisher's exact test and chi-square test were used in the quantitative statistical analysis. Results: Seventy-one percent of respondents reported some type of involvement in patient education. Knowledge as well as comfort level improved as years of oncology nursing experience increased. Generally, policies and procedures are in place; however, nurses noted there is a need for improved oral oncolytic guidelines. Nurses also reported a need for improved and updated educational resources. Conclusion: While the development of oral oncolytic agents continues to rise, findings show a need to develop evidence-based guidelines for nurses, which include management of oral oncolytic dosing, adverse events, and safety issues.

Managing hypersensitivity to asparaginase in pediatrics, adolescents, and young adults.

Hypersensitivity reactions to chemotherapeutic drugs have been documented for numerous cancer therapies. Clinical hypersensitivity to Escherichia coli asparaginase has been reported to range from 0% to 75%. Throughout the United States, nurses assume frontline responsibility for the assessment of asparaginase-related hypersensitivity reactions. It is essential that nurses educate themselves on the signs and symptoms of asparaginase-related hypersensitivity reactions as well as current supportive care approaches. The purpose of this review is to summarize acute lymphoblastic leukemia and the role of asparaginase and the pathology of allergic reactions. We will also update nurses on the differences in asparaginase preparations including dosing, half-life, rates of hypersensitivity, and routes of administration. A summary of current management and supportive care strategies will be provided as will a discussion of the relationship between allergy, antibodies, and asparaginase activity.