title: The use of Erwinia asparaginase for adult patients with acute lymphoblastic leukemia after pegaspargase intolerance.
abstract: Asparaginase administration has become a crucial component of front-line pediatric and pediatric-insipired multi-agent regimens for the treatment of acute lymphoblastic leukemia (ALL). The aim of this retrospective study was to assess the safety and feasibility of switching to Erwinia asparaginase after pegaspargase intolerance in adult ALL patients treated at Memorial Sloan Kettering Cancer Center. Our analysis included 10 patients, with a median age of 39 years (range 20-72), male predominance (90%), and a typical B-cell to T-cell ratio (70:30%) for ALL. Nine patients were switched to Erwinia asparaginase after pegaspargase hypersensitivity and one patient after grade 4 hyperbilirubinemia secondary to pegaspargase. With Erwinia asparaginase, no hypersensitivity reactions occurred and no patient developed other known clinical asparaginase-related toxicities. Laboratory adverse effects consisted of mostly mild elevation in liver enzymes. No morphologic relapses have occurred in any patient switched to Erwinia asparaginase in first remission at a follow up of 0.4-34.6 months. These findings are unique in that all of our patients received Erwinia asparaginase after hypersensitivity or intolerance to pegaspargase and 50% of them were older than 40 years of age, a population with very limited Erwinia asparaginase data. Our observations provide preliminary information that treatment with Erwinia asparaginase can proceed as scheduled in adult patients, despite pegaspargase hypersensitivity and possibly liver intolerance.
authors.affiliation: Department of Pharmacy, Memorial Sloan Kettering Cancer Center, New York, NY, USA. Electronic address: horvatt@mskcc.org.
authors.forename: Troy Z
authors.initials: TZ
authors.lastname: Horvat
authors.affiliation: Department of Pharmacy, Memorial Sloan Kettering Cancer Center, New York, NY, USA. Electronic address: Pecorarj@mskcc.org.
authors.forename: Joshua J
authors.initials: JJ
authors.lastname: Pecoraro
authors.affiliation: Department of Pharmacy, Memorial Sloan Kettering Cancer Center, New York, NY, USA. Electronic address: daleyr@mskcc.org.
authors.forename: Ryan J
authors.initials: RJ
authors.lastname: Daley
authors.affiliation: Department of Pharmacy, Memorial Sloan Kettering Cancer Center, New York, NY, USA. Electronic address: buiel@mskcc.org.
authors.forename: Larry W
authors.initials: LW
authors.lastname: Buie
authors.affiliation: Department of Pharmacy, Memorial Sloan Kettering Cancer Center, New York, NY, USA. Electronic address: kinga@mskcc.org.
authors.forename: Amber C
authors.initials: AC
authors.lastname: King
authors.affiliation: Leukemia Service, Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College, New York, NY, USA. Electronic address: rampalr@mskcc.org.
authors.forename: Raajit K
authors.initials: RK
authors.lastname: Rampal
authors.affiliation: Leukemia Service, Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College, New York, NY, USA. Electronic address: TallmanM@mskcc.org.
authors.forename: Martin S
authors.initials: MS
authors.lastname: Tallman
authors.affiliation: Leukemia Service, Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College, New York, NY, USA. Electronic address: ParkJ6@mskcc.org.
authors.forename: Jae H
authors.initials: JH
authors.lastname: Park
authors.affiliation: Leukemia Service, Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College, New York, NY, USA. Electronic address: Douer_d@med.usc.edu.
authors.forename: Dan
authors.initials: D
authors.lastname: Douer
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000970:Antineoplastic Agents / Q000009:adverse effects / Q000627:therapeutic use; D001215:Asparaginase / Q000009:adverse effects / Q000627:therapeutic use*; D057915:Drug Substitution; D004885:Erwinia / Q000201:enzymology; D005260:Female; D006801:Humans; D006967:Hypersensitivity; D008297:Male; D008875:Middle Aged; D011092:Polyethylene Glycols / Q000009:adverse effects*; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000150:complications / Q000188:drug therapy*; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D000970:Antineoplastic Agents; D011092:Polyethylene Glycols; C042705:pegaspargase; D001215:Asparaginase
keywords: ALL; Acute lymphoblastic leukemia; Erwinia asparaginase; Hypersensitivity; Pegaspargase; Safety