Melissa A Burns, Yael Flamand, Julia Keating, Victoria Koch, Sarah M Cronholm, Sarah K Hunt, Peter D Cole, Lisa M Gennarini, Nobuko Hijiya, Justine M Kahn, Kara M Kelly, Bruno Michon, Donna S Neuberg, Andrew E Place, Caroline Laverdière, Thai Hoa Tran, Yves Théorêt, Jennifer J G Welch, Stephen E Sallan, Lewis B Silverman, Lynda M Vrooman
Hypersensitivity reactions with pegylated Escherichia coli-derived asparaginase formulations are frequent and can complicate delivery of intended therapy for patients with acute lymphoblastic leukemia (ALL). On DFCI 16-001, which enrolled patients aged 1-21 years with newly diagnosed ALL, we piloted pegaspargase rechallenge after Grade 2 hypersensitivity reaction, including premedication and serum asparaginase activity (SAA) assessment. Among those who underwent rechallenge, the rechallenge dose was successfully administered (without reaction and with adequate SAA) in 41.3% of patients. This approach reduces the number of patients requiring switch to alternative asparaginase formulations, which have had limited availability and require frequent dosing.