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Asparaginase antibodies (AAAs) neutralize asparaginase and are often accompanied by a clinically overt allergic reaction, but in a proportion of the patients these antibodies occur without any signs of hypersensitivity, termed as silent inactivation.[1][1],[2][2] Vrooman et al. and Panosyan et al.

Desensitization protocol should not be used in acute lymphoblastic leukemia patients with silent inactivation of PEGasparaginase