title: How to manage asparaginase hypersensitivity in acute lymphoblastic leukemia.
abstract: Outcomes for children with acute lymphoblastic leukemia (ALL) have improved significantly in recent decades, primarily due to dose-intensified, multi-agent chemotherapy regimens, of which asparaginase has played a prominent role. Despite this success, hypersensitivity remains a significant problem, often requiring the termination of asparaginase. Failure to complete the entire asparaginase therapy course due to clinical hypersensitivity, subclinical hypersensitivity (i.e., silent inactivation), or other treatment-related toxicity is associated with poor ALL outcomes. Thus, it is critical to rapidly identify patients who develop clinical/subclinical hypersensitivity and switch these patients to an alternate asparaginase formulation. This article provides an overview of asparaginase hypersensitivity, identification and management of hypersensitivity and subclinical hypersensitivity, and issues related to switching patients to asparaginase Erwinia chrysanthemi following hypersensitivity reaction.
authors.affiliation: Division of Pediatric Oncology, Medical College of Wisconsin, Milwaukee, WI, USA. mmburke@mcw.edu.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Burke
mesh_terms: D000970:Antineoplastic Agents / Q000737:chemistry / Q000627:therapeutic use*; D001215:Asparaginase / Q000009:adverse effects / Q000627:therapeutic use*; D002626:Chemistry, Pharmaceutical; D002648:Child; D016974:Dickeya chrysanthemi / Q000201:enzymology; D006801:Humans; D006967:Hypersensitivity / Q000188:drug therapy* / Q000473:pathology; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000188:drug therapy* / Q000473:pathology
chemical_list: D000970:Antineoplastic Agents; D001215:Asparaginase
keywords: acute lymphoblastic leukemia; asparaginase; asparaginase Erwinia chrysanthemi; hypersensitivity; silent inactivation; therapeutic drug monitoring