Comparison of Allergic Reactions to Intravenous and Intramuscular Pegaspargase in Children with Acute Lymphoblastic Leukemia

Abstract

Pegaspargase (PEG) is a standard component of therapy for pediatric acute lymphoblastic leukemia (ALL). Because PEG preparations are bacterially derived, they are highly immunogenic. PEG has traditionally been delivered intramuscularly (IM), but over the last several years, more PEG has been given intravenously (IV) in order to provide a less painful and more convenient means of delivery. However, there are limited data comparing allergic reactions between IV and IM PEG recipients, especially in a large cohort of patients. We reviewed the charts of pediatric ALL patients diagnosed from 2006 to 2011 who received PEG at our institution and compared the incidence, time to onset of symptoms, reaction grade, and hospitalization rate for patients who had allergic reactions to PEG. Of 318 evaluable patients, 159 received IV and 159 received IM PEG. Thirty-one (19.5%) IV patients had an allergic reaction, compared to 17 (10.7%) IM patients (P = .028). Time to onset of symptoms was ≤ 30 minutes for 26 of 27 evaluable IV patients (96.3%) versus only two of 11 evaluable IM patients (18.2%; P < .001). Four of 31 IV patients (12.9%) and six of 17 IM patients (35.5%) required hospitalization (P = .134). There is increased incidence of allergy in patients who received IV PEG compared to IM. Grade of reaction was similar between IV and IM, but allergic reactions to IV PEG had a more rapid onset. While the risk of allergy may be increased, IV delivery appears to have an acceptable safety profile for administration in ALL patients.

Differentiating hypersensitivity versus infusion-related reactions in pediatric patients receiving intravenous asparaginase therapy for acute lymphoblastic leukemia

“…[14,[23][24][25]34,38,42,[46][47][48][49][50][51][52][53][54][55][56][57][58][59][60] Recently, a number of retrospective reports have compared the incidence of hypersensitivity between IV and IM PEG-asparaginase (Table 3). [8,34,[60][61][62][63][64] In a pediatric study of 318 patients, Petersen et al reported a 9% greater incidence of hypersensitivity following IV administration of PEG-asparaginase compared with IM PEG-asparaginase (p ¼ .028). [62] In addition, the DFCI identified an 11% overall incidence of hypersensitivity with IV PEGasparaginase in 232 children with ALL during consolidation.…”

“…[8,34,[60][61][62][63][64] In a pediatric study of 318 patients, Petersen et al reported a 9% greater incidence of hypersensitivity following IV administration of PEG-asparaginase compared with IM PEG-asparaginase (p ¼ .028). [62] In addition, the DFCI identified an 11% overall incidence of hypersensitivity with IV PEGasparaginase in 232 children with ALL during consolidation. [59] Of note, this incidence was identical to what Petersen et al [62] reported for patients receiving IM PEG-asparaginase.…”

“…[62] In addition, the DFCI identified an 11% overall incidence of hypersensitivity with IV PEGasparaginase in 232 children with ALL during consolidation. [59] Of note, this incidence was identical to what Petersen et al [62] reported for patients receiving IM PEG-asparaginase. Additionally, two recent reports of children treated in Children's Oncology Group (COG) trials reported differing results regarding the prevalence of hypersensitivity between IV and IM asparaginase in high-risk (HR) and standard-risk (SR) patients with B-ALL.…”

“…[47,62] Petersen et al [62] reported that 26 of 27 reactions (96%) occurred within 30 minutes of IV administration compared with only two of 11 (18%) reactions in patients receiving IM asparaginase. Henriksen et al [47] identified that in the subgroup of patients who experienced clinical hypersensitivity with IM asparaginase, 58% exhibited symptoms within two hours of administration.…”

Effect of Bcl-2-siRNA on proliferation and apoptosis of pediatric acute B lymphoblastic leukemia (A-BLL) cells

“…In addition, adhesives, coating, and floor covering, which are used in decoration, release toxic substances, such as formaldehyde, lead, and benzene, which severely damage the hemopoietic system of the human body. This is an important cause leading to a high incidence of childhood leukemia over the past few years Pana et al, 2014;Petersen et al, 2014). The VDLD therapeutic regime that has been used clinically is the first-line approach for treatment of A-BLL.…”