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Comparison of hypersensitivity rates to intravenous and intramuscular PEG‐asparaginase in children with acute lymphoblastic leukemia: A meta‐analysis and systematic review
Author(s) -
Hasan Haroon,
Shaikh Omar Mohammad,
Rassekh Shahrad Rod,
Howard A. Fuchsia,
Goddard Karen
Publication year - 2017
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.26200
Subject(s) - medicine , meta analysis , odds ratio , confidence interval , peg ratio , economics , finance
Background Pegylated‐asparaginase (PEG‐ASP) is a critical treatment for pediatric acute lymphoblastic leukemia (ALL) and has traditionally been delivered via intramuscular (IM) injection. In an attempt to reduce pain and anxiety, PEG‐ASP has increasingly been delivered via intravenous (IV) administration. The study objective was to perform a meta‐analysis and systematic review to compare and generate pooled hypersensitivity rates for IM and IV PEG‐ASP. Methods A systematic literature search was conducted for all epidemiological studies that investigated IV and IM hypersensitivity rates for pediatric ALL. Included studies were critically appraised using the GRACE checklist. Pooled estimates and odds ratios with 95% confidence intervals (CIs) for IM and IV hypersensitivity rates were derived based on either a random or fixed effects model. Results Four studies satisfied the inclusion criteria and were of adequate quality. The random effects pooled hypersensitivity rates were 23.5% (95% CI 14.7–33.7) and 8.7% (95% CI 5.4–12.8) for IV and IM, respectively. The fixed effects pooled odds ratio after adjusting for publication bias was 2.49 (95% CI 1.62–3.83), indicating a significantly higher risk of hypersensitivity for IV over IM PEG‐ASP. This risk is far more pronounced for high‐risk (HR) patients compared with standard‐risk (SR) patients (IV vs. IM: HR ↑35.2% and SR ↓2.9%). Conclusions Although administering PEG‐ASP through IV is preferable for patients, it poses a significantly higher risk of hypersensitivity when compared with IM administration, especially for HR patients. We recommend pediatric oncologists consider treating patients with HR pediatric ALL with IM PEG‐ASP to reduce the risk of hypersensitivity.