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Predictive factors for l-asparaginase hypersensitivity in pediatric acute lymphoblastic leukemia

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Abstract

Background

l-Asparaginase is a crucial component of acute lymphoblastic leukemia (ALL) treatment. However, hypersensitivity is a common adverse event. This study aimed to identify risk factors for l-asparaginase hypersensitivity in childhood ALL.

Methods

Children treated for ALL at Chiang Mai University Hospital, Thailand, between 2005 and 2020 were included. Demographic data, clinical characteristics, and factors related to l-asparaginase were retrospectively reviewed.

Results

l-Asparaginase hypersensitivity was observed in 24 of 216 children with ALL (11.1%). All patients received native l-asparaginase intramuscularly, and events occurred exclusively during the post-induction phase without concurrent corticosteroid use. Univariable analysis showed that relapsed ALL, higher accumulated doses, increased exposure days, and longer interval between drug administrations were potential risk factors. In multivariable logistic regression analysis, interruption of l-asparaginase administration for ≥ 52 weeks and exposure duration of ≥ 15 days were independent risk factors, with adjusted odds ratio of 16.481 (95% CI 3.248–83.617, p = 0.001) and 4.919 (95% CI 1.138–21.263, p = 0.033), respectively.

Conclusions

Children with ALL who require re-exposure to l-asparaginase after 52-week interruption or who have received l-asparaginase for ≥ 15 exposure days are at risk of develo** l-asparaginase hypersensitivity. Further management strategies in this setting should be evaluated.

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Acknowledgements

The authors thank Ms. Somjai Sittipreechacharn, and the Pediatric Hematology/Oncology staffs and nurses at the Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand, for their assistance.

Funding

The authors received no financial support for the research, authorship and/or publication of this article.

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Authors and Affiliations

  1. Division of Pediatric Hematology and Oncology, Department of Pediatrics, Faculty of Medicine, Chiang Mai University, 110 Intawaroros Road, Sriphum, Muang, Chiang Mai, 50200, Thailand

    Chane Choed-Amphai, Lalita Sathitsamitphong, Rungrote Natesirinilkul & Pimlak Charoenkwan

  2. Division of Pediatric Surgery, Department of Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand

    Jiraporn Khorana

  3. Center of Clinical Epidemiology and Clinical Statistic, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand

    Jiraporn Khorana

  4. Clinical Surgical Research Center, Department of Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand

    Jiraporn Khorana

  5. Thalassemia and Hematology Center, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand

    Pimlak Charoenkwan

Authors
  1. Chane Choed-Amphai
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  2. Jiraporn Khorana
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Contributions

CC conceived and designed the study. CC collected the data. CC and JK interpreted the results. CC wrote the original draft. JK, LS, and PC reviewed and revised the drafts. JK, LS, RN, and PC gave critical comments. All the authors were involved in the final revision of the article, gave contribution to the final analysis of the data and final approval.

Corresponding author

Correspondence to Chane Choed-Amphai.

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Conflict of interest

The authors do not have any financial or non-financial interests that are directly or indirectly related to the work submitted for publication.

Ethical approval

Approval was obtained from the Institutional Research Board/Ethics Committee (IRB/EC) of Chiang Mai University, Chiang Mai, Thailand.

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Not applicable.

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Not applicable.

Data availability

The datasets generated and analyzed for this study are available from the corresponding author upon reasonable request.

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Choed-Amphai, C., Khorana, J., Sathitsamitphong, L. et al. Predictive factors for l-asparaginase hypersensitivity in pediatric acute lymphoblastic leukemia. Int J Hematol 119, 442–449 (2024). https://doi.org/10.1007/s12185-024-03725-z

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  • DOI: https://doi.org/10.1007/s12185-024-03725-z

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