To evaluate how well antibodies to one asparaginase preparation predict or correlate with antibodies to another preparation in acute lymphoblastic leukemia (ALL) and lymphoma patients who did and did not have hypersensitivity reactions during chemotherapy. In all, 24 children with newly diagnosed ALL or lymphoma, who received Escherichia coli asparaginase 10 000 IU/ m 2 IM thrice weekly for nine doses as part of multiagent induction and reinduction chemotherapy, and seven monthly doses during the first 7 months of continuation treatment, were studied. Plasma samples were collected at postinduction and at postreinduction. Six of 24 patients had no overt clinical reactions (nonreacting) and received only the E. coli preparation. Of these, 18 patients who had allergic reactions were switched to Erwinia asparaginase. A total of 18 patients had an anaphylactoid reaction to Erwinia asparaginase and were switched to receive polyethylene glycol (PEG) asparaginase. Antibody levels were measured by enzyme-linked immunoadsorbent assay against all the three asparaginase preparations. At postinduction, antibodies against E. coli were higher in reacting patients (0.06370.066) than in nonreacting patients (0.01970.013) (P ¼ 0.03). At postreinduction, anti-Erwinia antibodies were significantly higher in reacting patients (0.43170.727) than in nonreacting patients (0.01870.009) (P ¼ 0.007). Anti-E. coli antibodies correlated with anti-PEG antibodies at postinduction (r ¼ 0.714, Po0.001) and at postreinduction (r ¼ 0.914, Po0.001), but did not correlate with anti-Erwinia antibodies at postinduction (r ¼ 0.119, P ¼ 0.580) and at postreinduction (r ¼ 0.078, P ¼ 0.716). The results indicate a crossreactivity between patient antibodies raised against natural E. coli and PEG asparaginase but not Erwinia asparaginase.

Polyethylene glycol-conjugated (PEG) asparaginase is approved for use in patients who develop allergy to other forms of asparaginase, although its ability to deplete asparagine systemically in patients with hypersensitivity has not been well elucidated. In 53 children with newly diagnosed acute lymphoblastic leukemia, we serially assessed asparagine concentrations in cerebrospinal fluid (CSF) and plasma as well as serum anti-asparaginase antibodies. All patients received native Escherichia coli (Elspar) asparaginase during induction therapy; patients received PEG asparaginase during reinductions when available, and those who developed allergy received Erwinia asparaginase. All eight patients who developed clinical evidence of allergy to asparaginase had anti-asparaginase antibodies. Among patients who had no antibodies, those who received E. coli had lower mean (7s.d.) CSF asparagine (0.2970.63, n ¼ 9) than those who received PEG (0.7770.82, n ¼ 4) (P ¼ 0.007). Results were similar for plasma asparagine. There was no situation where asparagine concentrations were more effectively depleted by PEG than by other preparations. None of the five patients who developed thrombosis had an allergy or antibodies to asparaginase at the time of the thrombosis. We conclude that asparagine concentrations were less effectively depleted by PEG than by E. coli asparaginase at the doses commonly used. The risk of thrombosis may be affected by the intensity of asparaginase exposure.

SUMMARY Background: This study evaluated the dose‐response relationship of torsemide, the first pyridine‐sulphonylurea loop diuretic, in patients with ascites due to cirrhosis. Methods: During a 13‐day hospitalization period, 17 patients received single, oral doses of 5 mg, 10 mg, or 20 mg of torsemide or placebo in a randomized, double‐blind, crossover fashion. All the patients received a constant dose of spironolactone concomitantly beginning at least 7 days before the study. Electrolyte excretion and urine volume were measured for 24 h after each dose. Body weight was measured before, and 24 h after each dose. Results: Torsemide was effective in producing statistically significant, dose‐related increases in urinary sodium and chloride excretion, with little effect on potassium or magnesium excretion. Urine volume increased and body weight decreased in a dose‐related manner. Conclusion: Torsemide increased sodium excretion substantially in patients with cirrhosis and ascites who were receiving spironolactone.