ArticlePediatric blood & cancer2019
Universal premedication and therapeutic drug monitoring for asparaginase-based therapy prevents infusion-associated acute adverse events and drug substitutions.
Article in Pediatric blood & cancer, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 22 papers, 2 of them syntheses that pooled it.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
22 citing papers in PubMed, 2 syntheses or guidelines pooled it, 66 citations in OpenAlex.
- Optimising Asparaginase Use and Managing Hypersensitivity in Australasia-A Clinical Practice Guideline From the Australian and New Zealand Children's Haematology/Oncology Group.Journal of paediatrics and child health · 2026Guideline
- American Society of Hematology 2026 guidelines for frontline management of acute lymphoblastic leukemia in adolescents and young adults.Blood advances · 2026Guideline
- Genetic predisposition of Asparaginase-induced hypertriglyceridemia in children with acute lymphoblastic leukemia: Two case reports and review of literature.World journal of clinical pediatrics · 2026Article
- Feasibility of therapeutic drug monitoring of asparaginase across multiple formulations in pediatric acute lymphoblastic leukemia.Blood research · 2026Article
- Prevention of Subsequent L-Asparaginase Hypersensitivity in Children Through Premedication: A Single-Center Experience.The journal of pediatric pharmacology and therapeutics : JPPT : the official journal of PPAG · 2026Article
- Practice of L-Asparaginase Usage: A Survey among Healthcare Providers Treating Children with Cancer in India.South Asian journal of cancer · 2025Article
- Pegaspargase induced multiple organ failure with acute lymphoblastic leukemia: A case report.World journal of clinical cases · 2025Article
- Predictive factors for L-asparaginase hypersensitivity in pediatric acute lymphoblastic leukemia.International journal of hematology · 2024Article
- Premedication Protocols to Prevent Hypersensitivity Reactions to Chemotherapy: a Literature Review.Clinical reviews in allergy & immunology · 2022Review
- Efficacy of a Standardized Premedication and Therapeutic Drug Monitoring Protocol for Pegaspargase to Prevent Hypersensitivity Reactions.The journal of pediatric pharmacology and therapeutics : JPPT : the official journal of PPAG · 2022Article
- Asparaginase in the Treatment of Acute Lymphoblastic Leukemia in Adults: Current Evidence and Place in Therapy.Blood and lymphatic cancer : targets and therapy · 2022Review
- Article
- Monitoring of treatment with L-asparaginase in children with acute lymphoblastic leukaemia, with a focus on silent inactivation and its influence on the treatment outcome.Contemporary oncology (Poznan, Poland) · 2022Article
- Current Use of Asparaginase in Acute Lymphoblastic Leukemia/Lymphoblastic Lymphoma.Frontiers in pediatrics · 2022Review
- Premedications for Cancer Therapies: A Primer for the Hematology/Oncology Provider.Journal of the advanced practitioner in oncology · 2021Review
- Pegaspargase in Practice: Minimizing Toxicity, Maximizing Benefit.Current hematologic malignancy reports · 2021Review
- Managing toxicities with asparaginase-based therapies in adult ALL: summary of an ESMO Open-Cancer Horizons roundtable discussion.ESMO open · 2020Review
- Increasing completion of asparaginase treatment in childhood acute lymphoblastic leukaemia (ALL): summary of an expert panel discussion.ESMO open · 2020Review
- Impact of Asparaginase Discontinuation on Outcome in Childhood Acute Lymphoblastic Leukemia: A Report From the Children's Oncology Group.Journal of clinical oncology : official journal of the American Society of Clinical Oncology · 2020Article
- Article
Corrections and comments
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Authors and funding
6 authors at 2 institutions in 1 country.
Funding
Abstract
backgroundAsparaginase is a critical component of lymphoblastic leukemia therapy, with intravenous pegaspargase (PEG) as the current standard product. Acute adverse events (aAEs) during PEG infusion are difficult to interpret, representing a mix of drug-inactivating hypersensitivity and noninactivating reactions. Asparaginase Erwinia chrysanthemi (ERW) is approved for PEG hypersensitivity, but is less convenient, more expensive, and yields lower serum asparaginase activity (SAA). We began a policy of universal premedication and SAA testing for PEG, hypothesizing this would reduce aAEs and unnecessary drug substitutions. PROCEDURE: Retrospective chart review of patients receiving asparaginase before and after universal premedication before PEG was conducted, with SAA performed 1 week later. We excluded patients who had nonallergic asparaginase AEs. Primary end point was substitution to ERW. Secondary end points included aAEs, SAA testing, and cost.
resultsWe substituted to ERW in 21 of 122 (17.2%) patients pre-policy, and 5 of 68 (7.4%) post-policy (RR, 0.427; 95% CI, 0.27-0.69, P = 0.028). All completed doses of PEG yielded excellent SAA (mean, 0.90 units/mL), compared with ERW (mean, 0.15 units/mL). PEG inactivation post-policy was seen in 2 of 68 (2.9%), one silent and one with breakthrough aAE. The rate of aAEs pre/post-policy was 17.2% versus 5.9% (RR, 0.342; 95% CI, 0.20-0.58, P = 0.017). Grade 4 aAE rate pre/post-policy was 15% versus 0%. Cost analysis predicts $125 779 drug savings alone per substitution prevented ($12 402/premedicated patient).
conclusionsUniversal premedication reduced substitutions to ERW and aAE rate. SAA testing demonstrated low rates of silent inactivation, and higher SAA for PEG. A substantial savings was achieved. We propose universal premedication for PEG be standard of care.
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