Case series of desensitization to pegylated escherichia coli-derived asparaginase: An effective option in response to the need.

INTRODUCTION

Asparaginase is an integral component in the treatment of acute lymphoblastic leukemia. The asparaginase products available in our country are Escherichia Coli (E. Coli)-derived asparaginase (Leunase), pegaspargase (Oncaspar), and, to a lesser extent, Erwinia chrysanthemi-derived asparaginase. Hypersensitivity reactions (HSR) are reported less frequently in those receiving pegaspargase, ranging from 3% to 15%; however, these reactions can limit its use in this population.

CASE REPORT: We present four patients with B-cell ALL who experienced a severe allergic HSR, anaphylaxis, leading us to perform a 12-step desensitization protocol to pegaspargase to ensure that the patients received first-line treatment for their oncologic condition.

MANAGEMENT AND OUTCOMES: Skin tests were performed, with positive results in two out of four patients. Subsequently, a 12-step desensitization protocol was carried out. Pegaspargase was diluted with 0.9% saline solution in three bags (concentrations 1:100, 1:10, and 1:1). Infusions used four steps per bag titrated every 15 minutes up to a maximum rate of 80 mL/hour for step 12. A successful administration of pegaspargase was achieved, and the patients continued with their ALL treatment.