ALLERGIC REACTION TO ESCHERICHIA COLI-ASPARAGINASE IN CHILDHOOD ACUTE LYMPHOBLASTIC LEUKEMIA: A STUDY IN A TERTIARY HOSPITAL IN INDONESIA
Objective: The objective of the study was to determine and describe the characteristics of allergic reactions to Escherichia coli-Asparaginase (E. coli-ASP).
Methods: This cross-sectional study was performed at Hasan Sadikin Bandung General Hospital on acute lymphoblastic leukemia patients diagnosed from January 1, 2018, to August 31, 2019, confirmed by bone marrow examination. Data were extracted from Bandung Online Pediatric Cancer Registry, medical records, protocol therapy documents, and interview with patient’s guardian.
Results: Out of 68 patients, 26 patients (37.6%) were allergic to E. coli-ASP. Twenty-two patients with recorded manifestation’s data evoked 35 symptoms and graded according to common terminology criteria for adverse event v3.0., fever, and urticaria are the most frequent manifestation. While Grade 2 and Grade 3 are the most often developed allergic reaction, patients with age range from 1 to 14 years, male and high risk is mainly allergic.
Conclusion: Allergic rate to E. coli-ASP at Hasan Sadikin General Hospital is 37.6%. The most frequent manifestation is fever and urticaria (20%, respectively), Grades 2 and 3 (32%, respectively), and emerged mostly after administration of fourth dose E. coli-ASP (26.9%). Despite the characteristic differences between allergic and non-allergic group, it is not statistically significant.
2. Pui CH, Evans WE. A 50-year journey to cure childhood acute lymphoblastic leukemia. Semin Hematol 2013;50:185-96.
3. Sitaresmi MN, Mostert S, Schook RM, Sutaryo, Veerman AJ. Treatment refusal and abandonment in childhood acute lymphoblastic leukemia in Indonesia: An analysis of causes and consequences. Psychooncology 2010;19:361-7.
4. Sitaresmi MN, Mostert S, Purwanto I, Gundy CM, Sutaryo, Veerman AJ. Chemotherapy-related side effects in childhood acute lymphoblastic leukemia in Indonesia: Parental perceptions. J Pediatr Oncol Nurs 2009;26:198-207.
5. Sari N, Reniarti L, Suryawan N, Susanah S, Wahyudi K. Burden of pediatric cancer treatment: Results of online pediatric cancer registry prototype 1 at a third referral hospital in Indonesia. Althea Med J 2017;4:465. Available from: http://www.journal.fk.unpad.ac.id/index. php/amj/article/view/1204.
6. Pramila P, Abraham A, Pawar S, Bafna V, Bansal M. To study the therapeutic management, drug related problems and concomitant use of drugsin patients with cancer. Int J Appl Pharm 2017;6:139-44.
7. Cooper SL, Brown PA. Treatment of pediatric acute lymphoblastic leukemia. Pediatr Clin North Am 2015;62:61-73.
8. Ikatan Dokter Anak Indonesia. UKK Hemato Onkologi. Buku Panduan Protokol Nasional Leukemia Limfoblastik Akut 2018, Indonesia; 2018.
9. Asselin B, Rizzari C. Asparaginase pharmacokinetics and implications of therapeutic drug monitoring. Leuk Lymphoma 2015;56:2273-80.
10. Al-Mashhadani Z, Naser RA, Zalzala MH. The impact of new targeting methods in the cancer therapy. Int J Appl Pharm 2019;11:1-6.
11. Gupta M, Dahiya J, Marwaha, Dureja H. Therapies in cancer treatment: An overview. Int J Pharm Pharm Sci 2015;7:1-9.
12. Hijiya N, Van Der Sluis IM. Asparaginase-associated toxicity in children with acute lymphoblastic leukemia. Leuk Lymphoma 2016;57:748-57.
13. Raetz EA, Salzer WL. Tolerability and efficacy of L-asparaginase therapy in pediatric patients with acute lymphoblastic leukemia. J Pediatr Hematol Oncol 2010;32:554-63.
14. Woo MH, Hak LJ, Storm MC, Sandlund JT, Ribeiro RC, Rivera GK, et al. Hypersensitivity or development of antibodies to asparaginase does not impact treatment outcome of childhood acute lymphoblastic leukemia. J Clin Oncol 2000;18:1525-32.
15. Zalewska-Szewczyk B, Andrzejewski W, M?ynarski W, Jedrychowska- Da?ska K, Witas H, Bodalski J. The anti-asparagines antibodies correlate with L-asparagines activity and may affect clinical outcome of childhood acute lymphoblastic leukemia. Leuk Lymphoma 2007;48:931-6.
16. Avramis VI, Tiwari PN. Asparaginase (native ASNase or pegylated ASNase) in the treatment of acute lymphoblastic leukemia. Int J Nanomedicine 2006;1:241-54.
17. Liu C, Kawedia JD, Cheng C, Pei D, Fernandez CA, Cai X, et al. Clinical utility and implications of asparaginase antibodies in acute lymphoblastic leukemia. Leukemia 2012;26:2303-9.
18. Burke MJ. How to manage asparaginase hypersensitivity in acute lymphoblastic leukemia. Future Oncol 2014;10:2615-27.
19. Ribeiro RC, Gupta S, Antillon FA, Sung L, Howard SC, Fu L, et al. Treatment-related mortality in children with acute lymphoblastic leukemia in Central America. Cancer 2011;117:4788-95.
20. Narta UK, Kanwar SS, Azmi W. Pharmacological and clinical evaluation of L-asparaginase in the treatment of leukemia. Crit Rev Oncol Hematol 2007;61:208-21.
21. Krishna M, Nadler SG. Immunogenicity to biotherapeutics-the role of anti-drug immune complexes. Front Immunol 2016;7:21.
22. Woo MH, Hak LJ, Storm MC, Evans WE, Sandlund JT, Rivera GK, et al. Anti-asparaginase antibodies following E. coli asparaginase therapy in pediatric acute lymphoblastic leukemia. Leukemia 1998;12:1527-33.
23. Santos AC, Land MG, Silva NP, Santos KO, Lima-Dellamora ED. Reactions related to asparaginase infusion in a 10-year retrospective cohort. Rev Bras Hematol Hemoter 2017;39:337-42.
24. Burke MJ, Rheingold SR. Differentiating hypersensitivity versus infusion-related reactions in pediatric patients receiving intravenous asparaginase therapy for acute lymphoblastic leukemia. Leuk Lymphoma 2017;58:540-51.
25. Pieters R, Hunger SP, Boos J, Rizzari C, Silverman L, Baruchel A, et al. L-asparaginase treatment in acute lymphoblastic leukemia: A focus on Erwinia asparaginase. Cancer 2011;117:238-49.
26. Bahadir A, Abul MH, Reis PG, Erduran E, Orhan F. Adverse skin reactions caused by L-asparaginase: Allergy or infection. Asthma Allergy Immunol 2015;13:130-3. Available from: http://www.aai.org. tr/index.php/aai/article/view/70/7.
27. Asselin B. Immunology of infusion reactions in the treatment of patients with acute lymphoblastic leukemia. Future Oncol 2016;12:1609-21.
28. Avramis VI, Tiwari PN. Asparaginase (native ASNase or pegylated ASNase) in the treatment of acute lymphoblastic leukemia. Int J Nanomedicine 2006;1:241-54.
29. Nussbaum V, Lubcke N, Findlay R. Hyperammonemia secondary to asparaginase: A case series. J Oncol Pharm Pract 2016;22:161-4.
30. Gerson SL, Caimi PF, William BM, Creger RJ. Pharmacology and molecular mechanisms of antineoplastic agents for hematologic malignancies. In: Hoffman R, Benz EJ Jr., Silberstein LE, Heslop H, Anastasi J, Weitz J. Hematology: Basic Principles and Practice. 7th ed. Philadelphia, PA: Elsevier; 2018. p. 890-910.
31. Konstantinidis N, Kolarovic J, Kacanski N, Vijatov-Djuric G, Konstantinidis G. Allergic complications of L-asparaginase therapy in children with acute lymphoblastic leukemia. Srp Arh Celok Lek 2011;139(11-12):749-52.
32. Raji? V, Debeljak M, Gori?ar K, Jazbec J. Polymorphisms in GRIA1 gene are a risk factor for asparaginase hypersensitivity during the treatment of childhood acute lymphoblastic leukemia. Leuk Lymphoma 2015;56:3103-8.
33. Hasan H, Shaikh OM, Rassekh SR, Howard AF, Goddard K. Comparison of hypersensitivity rates to intravenous and intramuscular PEG-asparaginase in children with acute lymphoblastic leukemia: A meta-analysis and systematic review. Pediatr Blood Cancer 2017;64:81-8.
34. Barry E, DeAngelo DJ, Neuberg D, Stevenson K, Loh ML, Asselin BL, et al. Favorable outcome for adolescents with acute lymphoblastic leukemia treated on Dana-Farber cancer institute acute lymphoblastic leukemia consortium protocols. J Clin Oncol 2007;25:813-9.
This work is licensed under a Creative Commons Attribution 4.0 International License.
The publication is licensed under CC By and is open access. Copyright is with author and allowed to retain publishing rights without restrictions.