Outcomes Following Discontinuation of E-coli l-Asparaginase Upon Severe Allergic Reactions in Children With Acute Lymphoblastic Leukemia

BackgroundDiscontinuation of E. colil-asparaginase in patients with acute lymphoblastic leukemia (ALL) is unavoidable upon severe allergic reaction. We sought to examine outcomes following E. colil-asparaginase discontinuation due to severe allergic reactions. ProcedureWe evaluated the outcome of children enrolled in Taiwan Pediatric Oncology Group-2002-ALL protocol between 2002 and 2012, who had E. colil-asparaginase discontinued due to severe allergic reactions, and compared the outcomes of those who continued with Erwinia l-asparaginase (Erwinase) with those who did not. ResultsAmong 700 patients enrolled in this study, 33 patients had E. colil-asparaginase treatment discontinued due to severe allergic reactions. Five-year overall survival did not differ significantly among the 648 patients without discontinuation (81 1.6%, mean +/- SE), compared to 17 patients with allergic reactions and treated with Erwinase (88 +/- 7.8%) and 16 patients with allergic reactions but not treated with Erwinase (87 +/- 8.6%). Among 16 patients who did not receive Erwinase, all 10 who received 50% of the scheduled doses of E. colil-asparaginase before discontinuation survived without events. ConclusionsErwinase treatment may not be needed for some ALL patients with severe allergy to E. colil-asparaginase if 50% of prescribed doses were received and/or therapy is augmented with other agents.