Comparison of allergic reactions to pegasparaginase given intravenously versus intramuscularly
Comparison of allergic reactions to pegasparaginase given intravenously versus intramuscularly
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DOI：
10.1002/pbc.23380
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发表时间：
2012-09-01
影响因子：
3.2
通讯作者：
Bostrom, Bruce
中科院分区：
文献类型：
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作者：
Pidaparti, Mahati;Bostrom, Bruce
背景 聚门冬酰胺酶 (PEG) 对于治疗急性淋巴细胞白血病 (ALL) 非常重要。尽管与聚乙二醇结合以降低免疫原性，但过敏反应仍然发生并且可能很严重。传统上，PEG 通过肌内 (IM) 注射给药，但最近的方案表明它可以安全地静脉内 (IV) 给药，这可能是患者的首选。人们可能担心，静脉注射途径可能会因立即暴露于血液中的反应性抗体而导致更严重的过敏反应，而肌肉注射后会延迟这种反应。我们研究的目的是比较 IV 与 IM PEG 过敏反应的严重程度和发生率。我们不知道之前有任何研究对此进行检验。程序 我们回顾了 2005 年至 2010 年诊断的所有接受 PEG 治疗并出现过敏反应的 ALL 患者。使用通用毒性标准 (CTC) 3.0 和 4.0 对反应进行分级。结果 186 名接受 IM PEG 治疗的新诊断患者中有 17 名（9%）出现过敏反应，接受 IV PEG 的 11 名患者中有 4 名（36%）出现过敏反应； P?=?0.019。与 IM 相比，IV 反应的严重程度并未增加。与标准风险患者（112 名患者中的 7 名；6%）相比，高风险患者（85 名患者中的 14 名；16%）过敏反应发生频率更高，P = 0.034。结论 与 IM 治疗相比，接受 IV PEG 治疗的患者过敏反应发生率似乎有所增加，尽管严重程度相似。此外，高风险患者似乎比标准风险患者有更多的过敏反应。儿科血癌 2012；59：436439。 (c) 2011 年 Wiley 期刊公司。
Background Pegasparaginase (PEG) is important for treatment of Acute Lymphoblastic Leukemia (ALL). Despite conjugation to polyethylene glycol to reduce immunogenicity, allergic reactions still occur and may be severe. Traditionally, PEG is given via intramuscular (IM) injection but recent protocols have shown it can be safely given intravenously (IV), which may be preferred by patients. There is a potential concern that the IV route may result in more severe allergic reactions due to immediate exposure to reactive antibodies in the blood, which is delayed after IM administration. The purpose of our study is to compare the severity and incidence of allergic reactions with IV versus IM PEG. We are unaware of any prior studies examining this. Procedure We reviewed all patients with ALL diagnosed from 2005 to 2010 inclusive who received PEG and had an allergic reaction. Reactions were graded using both common toxicity criteria (CTC) 3.0 and 4.0. Results Allergic reactions were seen in 17 of 186 (9%) newly diagnosed patients receiving IM PEG and 4 of 11 (36%) receiving IV PEG; P?=?0.019. The severity of reaction was not increased with IV versus IM. Allergic reactions occurred more frequently in high-risk patients (14 of 85; 16%) versus standard risk (7 of 112; 6%), P?=?0.034. Conclusions There appears to be an increased incidence of allergic reactions in patients who receive IV PEG compared with IM although the severity is similar. In addition high-risk patients appear to have more allergic reactions than standard risk. Pediatr Blood Cancer 2012;59:436439. (c) 2011 Wiley Periodicals, Inc.