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Outcomes Following Discontinuation of E. coli l ‐Asparaginase Upon Severe Allergic Reactions in Children With Acute Lymphoblastic Leukemia
Author(s) -
Yen HsiuJu,
Chang WanHui,
Liu HsiChe,
Yeh TingChi,
Hung GiunYi,
Wu KangHsi,
Peng ChingTien,
Chang YuHsiang,
Chang TeKao,
Hsiao ChihCheng,
Sheen JiunnMing,
Chao YuHua,
Chang TaiTsung,
Chiou ShyhShin,
Lin PeiChin,
Wang ShihChung,
Lin MingTsan,
Ho WanLing,
Chen YuChieh,
Liang DerCherng
Publication year - 2016
Publication title -
pediatric blood and cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.116
H-Index - 105
eISSN - 1545-5017
pISSN - 1545-5009
DOI - 10.1002/pbc.25869
Subject(s) - discontinuation , medicine , asparaginase , lymphoblastic leukemia , allergic reaction , hypogammaglobulinemia , pediatrics , gastroenterology , leukemia , allergy , immunology , antibody
Background Discontinuation of E. coli l ‐asparaginase in patients with acute lymphoblastic leukemia (ALL) is unavoidable upon severe allergic reaction. We sought to examine outcomes following E. coli l ‐asparaginase discontinuation due to severe allergic reactions. Procedure We evaluated the outcome of children enrolled in Taiwan Pediatric Oncology Group‐2002‐ALL protocol between 2002 and 2012, who had E. coli l ‐asparaginase discontinued due to severe allergic reactions, and compared the outcomes of those who continued with Erwinia l ‐asparaginase (Erwinase) with those who did not. Results Among 700 patients enrolled in this study, 33 patients had E. coli l ‐asparaginase treatment discontinued due to severe allergic reactions. Five‐year overall survival did not differ significantly among the 648 patients without discontinuation (81 ± 1.6%, mean ± SE), compared to 17 patients with allergic reactions and treated with Erwinase (88 ± 7.8%) and 16 patients with allergic reactions but not treated with Erwinase (87 ± 8.6%). Among 16 patients who did not receive Erwinase, all 10 who received ≥50% of the scheduled doses of E. coli l ‐asparaginase before discontinuation survived without events. Conclusions Erwinase treatment may not be needed for some ALL patients with severe allergy to E. coli l ‐asparaginase if ≥50% of prescribed doses were received and/or therapy is augmented with other agents.