Continuous PEGasparaginase Dosing Reduces Hypersensitivity Reactions in Pediatric ALL: A Dutch Childhood Oncology Group ALL11 Randomized Trial
Journal of Clinical Oncology, vol. 42, pp. 1676–1686
Abstract
PURPOSE The primary objective of this randomized study was to determine whether a continuous dosing schedule (without the asparaginase-free interval) would result in less hypersensitivity reactions to PEGasparaginase (PEGasp) compared with the standard noncontinuous dosing schedule. METHODS Eight hundred eighteen patients (age 1-18 years) with ALL were enrolled in the Dutch Childhood Oncology Group-ALL11 protocol and received PEGasp. Three hundred twelve patients stratified in the medium-risk arm were randomly assigned to receive 14 individualized PEGasp doses once every two weeks in either a noncontinuous or continuous schedule after the first three doses in induction (EudraCT: 2012-000067-25). Hypersensitivity reactions were defined as allergies, allergic-like reactions, and silent inactivation. Secondary end points were other asparaginase-related toxicities, asparaginase activity and antibody levels, and outcome. RESULTS During induction, 27 of 818 patients (3.3%) experienced hypersensitivity reactions. After random assignment, 4 of 155 (2.6%) in the continuous treatment arm versus 17 of 157 (10.8%) patients in the noncontinuous treatment arm had hypersensitivity reactions ( P < .01), of which two (1.3%) versus 13 (8.3%) were inactivating reactions ( P < .01). The occurrence of inactivating hypersensitivity reactions was seven times lower in the continuous arm (odds ratio, 0.15 [0.032-0.653]). In addition, antibody levels were significantly lower in the continuous arm ( P < .01). With exception of a lower incidence of increased amylase in the continuous arm, there were no significant differences in total number of asparaginase-associated toxicities between arms. However, the timing of the toxicities was associated with the timing of the asparaginase administrations. No difference in 5-year cumulative incidence of relapse, death, or disease-free survival was found between both treatment arms. CONCLUSION A continuous dosing schedule of PEGasp is an effective approach to prevent antibody formation and inactivating hypersensitivity reactions. The continuous PEGasp schedule did not increase toxicity and did not affect the efficacy of the therapy.
Authors 11
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Affiliation as printed
Dutch Childhood Oncology Group, Utrecht, the Netherlands
Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
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Princess Máxima Center · Erasmus MC - Sophia Children’s Hospital
Affiliation as printed
Pediatric Oncology and Hematology, Erasmus MC–Sophia Children's Hospital, Rotterdam, the Netherlands
Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
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Leiden University · Leiden University Medical Center · Princess Máxima Center
Affiliation as printed
Department of Biomedical Data Sciences, Medical Statistics, Leiden University Medical Center, Leiden, the Netherlands
Mathematical Institute, Leiden University, the Netherlands
Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
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Affiliation as printed
Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
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Affiliation as printed
Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
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Affiliation as printed
Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
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Affiliation as printed
Dutch Childhood Oncology Group, Utrecht, the Netherlands
Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
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Affiliation as printed
Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
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Affiliation as printed
Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
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Affiliation as printed
Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
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Affiliation as printed
Dutch Childhood Oncology Group, Utrecht, the Netherlands
Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
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