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Hypersensitivity reactions to asparaginase therapy in acute lymphoblastic leukemia: immunology and clinical consequences. Future Oncol 2022 Mar;18(10):1285-1299

Date

02/03/2022

Pubmed ID

35107320

DOI

10.2217/fon-2021-1288

Scopus ID

2-s2.0-85126490475   1 Citation

Abstract

Asparaginase is commonly used in combination therapy of acute lymphoblastic leukemia. However, as an immunogenic protein, hypersensitivity reactions (HSRs) during asparaginase therapy are frequent, indicating the development of anti-asparaginase antibodies. These can be associated with diminished clinical effectiveness, including poorer survival. Therapeutic drug monitoring of serum asparaginase activity to confirm complete asparagine depletion is therefore crucial during asparaginase therapy. Switching to alternative types of asparaginase is recommended for patients experiencing HSRs or silent inactivation; those with HSRs or silent inactivation on Escherichia coli-derived asparaginases should switch to another preparation. However, prior global shortages of Erwinia asparaginase highlight the importance of alternative non-E. coli-derived asparaginase, including recombinant Erwinia asparaginase.

Author List

Burke MJ, Zalewska-Szewczyk B

Author

Michael James Burke MD Professor in the Pediatrics department at Medical College of Wisconsin




MESH terms used to index this publication - Major topics in bold

Adolescent
Antineoplastic Agents
Asparaginase
B-Lymphocytes
Child
Drug Hypersensitivity
Drug Monitoring
Female
Humans
Immunoglobulin M
Male
Precursor Cell Lymphoblastic Leukemia-Lymphoma
T-Lymphocytes, Helper-Inducer