D2.238 - Successful Prevention of Subsequent L-Asparaginase Hypersensitivity in Children through Premedication: A Single-Center Experience

L-asparaginase is a crucial component of pediatric acute lymphoblastic leukemia (ALL) treatment. However, hypersensitivity reactions can occur, necessitating a switch to alternative asparaginase formulations. In resource-limited settings, access to peg-asparaginase and Erwinia asparaginase may be limited. The aim of the study is to evaluate the efficacy of a premedication protocol in preventing subsequent L-asparaginase hypersensitivity reactions in children with a history of severe reactions to native E. coli L-asparaginase.

A retrospective review was conducted of 7 ALL patients who experienced prior severe systemic hypersensitivity reactions to native E. coli L-asparaginase. A premedication protocol was implemented, including prednisolone, cetirizine, montelukast, and hydrocortisone, administered prior to subsequent native E. coli L-asparaginase doses.

A total of 33 subsequent native E. coli L-asparaginase doses were administered in 7 children following premedication. Four patients experienced mild hypersensitivity reactions, which were managed with antihistamines and steroids. All seven patients successfully completed their prescribed course of L-asparaginase therapy.

In resource-limited settings, this premedication protocol demonstrated potential for safely enabling continued native E. coli L-asparaginase therapy in children with a history of severe hypersensitivity reactions, potentially improving treatment outcomes.