Use of Universal Premedication in the Prevention of Allergic Reactions to PEGylated-Asparaginase in Children and Adolescents With Acute Lymphoblastic Leukemia and Lymphoblastic Lymphoma.

Asparaginase is an established chemotherapeutic agent for acute lymphoblastic leukemia (ALL) and lymphoblastic lymphoma (LL) treatment. Pegylated asparaginase (PEG-Asp) is first-line but may lead to allergic reactions in ∼30% of recipients, leading to substitution by Erwinia -derived asparaginase. Studies demonstrate mixed results on the impact of universal premedication on the incidence of infusion reactions. Our center adopted universal premedication with H1 and H2 antagonists and nadir serum asparaginase activity (SAA) level monitoring in 2019. We assessed the impact of universal premedication on hypersensitivity reactions. We reviewed 107 pediatric ALL/LL patients who received 355 PEG-Asp doses, comparing the frequency of hypersensitivity reactions before universal premedication (PM - ) from 2016 to 2018 and after implementation (PM + ) from 2019 to 2021. No significant difference in reactions was observed between PM - (13 reactions, 27%) and PM + (10 reactions, 17%) patients across all risk stratifications ( P =0.25) or in the severity of reactions. SAA monitoring identified 2 patients (4%) with silent inactivation. The number of Erwinia doses administered between groups did not differ significantly (325 vs. 210, P =0.13). Universal premedication with H1 and H2 antagonists did not impact the number or grade of hypersensitivity reactions to PEG-Asp. We suggest SAA monitoring for patients receiving PEG-Asp to identify silent inactivations.