title: Outcomes Following Discontinuation of E. coli l-Asparaginase Upon Severe Allergic Reactions in Children With Acute Lymphoblastic Leukemia.
abstract: 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.
  
  
  METHODS
  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.
authors.affiliation: Department of Pediatrics, Taipei Veterans General Hospital and School of Medicine, National Yang-Ming University, Taipei, Taiwan.|Department of Life Science, National Taiwan Normal University, Taipei, Taiwan.
authors.forename: Hsiu-Ju
authors.initials: HJ
authors.lastname: Yen
authors.affiliation: Biostatistical Center, Childhood Cancer Foundation, Taipei, Taiwan.
authors.forename: Wan-Hui
authors.initials: WH
authors.lastname: Chang
authors.affiliation: Department of Pediatrics, Mackay Memorial Hospital, and Mackay Medical College, Taipei, Taiwan.
authors.forename: Hsi-Che
authors.initials: HC
authors.lastname: Liu
authors.affiliation: Department of Pediatrics, Mackay Memorial Hospital, and Mackay Medical College, Taipei, Taiwan.
authors.forename: Ting-Chi
authors.initials: TC
authors.lastname: Yeh
authors.affiliation: Department of Pediatrics, Taipei Veterans General Hospital and School of Medicine, National Yang-Ming University, Taipei, Taiwan.|Department of Life Science, National Taiwan Normal University, Taipei, Taiwan.
authors.forename: Giun-Yi
authors.initials: GY
authors.lastname: Hung
authors.affiliation: Department of Pediatric Hemato/Oncology, Children's Hospital of China Medical University, Taichung, Taiwan.
authors.forename: Kang-Hsi
authors.initials: KH
authors.lastname: Wu
authors.affiliation: Department of Pediatric Hemato/Oncology, Children's Hospital of China Medical University, Taichung, Taiwan.
authors.forename: Ching-Tien
authors.initials: CT
authors.lastname: Peng
authors.affiliation: Department of Pediatrics, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.
authors.forename: Yu-Hsiang
authors.initials: YH
authors.lastname: Chang
authors.affiliation: Department of Pediatrics, Taichung Veterans General Hospital, Taichung, Taiwan.
authors.forename: Te-Kao
authors.initials: TK
authors.lastname: Chang
authors.affiliation: Department of Pediatrics, Chang Gung Children's Hospital-Kaohsiung, Kaohsiung, Taiwan.
authors.forename: Chih-Cheng
authors.initials: CC
authors.lastname: Hsiao
authors.affiliation: Department of Pediatrics, Chang Gung Children's Hospital-Kaohsiung, Kaohsiung, Taiwan.
authors.forename: Jiunn-Ming
authors.initials: JM
authors.lastname: Sheen
authors.affiliation: Department of Pediatrics, Chung Shan Medical University Hospital, Taichung, Taiwan.
authors.forename: Yu-Hua
authors.initials: YH
authors.lastname: Chao
authors.affiliation: Department of Pediatrics, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
authors.forename: Tai-Tsung
authors.initials: TT
authors.lastname: Chang
authors.affiliation: Department of Pediatrics, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
authors.forename: Shyh-Shin
authors.initials: SS
authors.lastname: Chiou
authors.affiliation: Department of Pediatrics, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
authors.forename: Pei-Chin
authors.initials: PC
authors.lastname: Lin
authors.affiliation: Department of Pediatrics, Changhua Christian Hospital, Changhua, Taiwan.
authors.forename: Shih-Chung
authors.initials: SC
authors.lastname: Wang
authors.affiliation: Department of Pediatrics, Changhua Christian Hospital, Changhua, Taiwan.
authors.forename: Ming-Tsan
authors.initials: MT
authors.lastname: Lin
authors.affiliation: Department of Pediatrics, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan.|School of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan.
authors.forename: Wan-Ling
authors.initials: WL
authors.lastname: Ho
authors.affiliation: Department of Pediatrics, Chang Gung Children's Hospital-Kaohsiung, Kaohsiung, Taiwan.
authors.forename: Yu-Chieh
authors.initials: YC
authors.lastname: Chen
authors.affiliation: Department of Pediatrics, Mackay Memorial Hospital, and Mackay Medical College, Taipei, Taiwan.
authors.forename: Der-Cherng
authors.initials: DC
authors.lastname: Liang
mesh_terms: D000970:Antineoplastic Agents / Q000009:adverse effects*; D001215:Asparaginase / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D018572:Disease-Free Survival; D004342:Drug Hypersensitivity; D004926:Escherichia coli; D005260:Female; D006801:Humans; D007223:Infant; D053208:Kaplan-Meier Estimate; D008297:Male; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000188:drug therapy* / Q000401:mortality
chemical_list: D000970:Antineoplastic Agents; D001215:Asparaginase
keywords: E. coli
  l-asparaginase; acute lymphoblastic leukemia; children; discontinuation; outcome; severe allergy