{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T09:36:53Z","timestamp":1792057013604,"version":"4.4.0"},"reference-count":24,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2024,2,4]],"date-time":"2024-02-04T00:00:00Z","timestamp":1707004800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2024,2,4]],"date-time":"2024-02-04T00:00:00Z","timestamp":1707004800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pediatric Blood &amp;amp; Cancer"],"published-print":{"date-parts":[[2024,4]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>\n                      Pegaspargase is a therapeutic enzyme that is utilized in treatment regimens targeting pediatric acute lymphoblastic leukemia. However, many patients experience hypersensitivity reactions, requiring discontinuation of the therapy. Historically, this necessitated switching to an alternative form of the drug, most commonly asparaginase\n                      <jats:italic>Erwinia chrysanthemi<\/jats:italic>\n                      ; however, in recent years this was difficult due to drug shortages and eventually commercial discontinuation. We report here our experience performing pegaspargase desensitizations in patients with prior hypersensitivity reactions.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Procedure<\/jats:title>\n                    <jats:p>Patients with a clinical hypersensitivity reaction to pegaspargase were identified. When due for their next dose, patients were admitted to the pediatric intensive care unit, bone marrow transplant unit, or oncology unit, and underwent desensitization utilizing a rigorous premedication and multistep dilution\u2010based protocol. Serum asparaginase activity levels were drawn after desensitization to assess for therapeutic levels of enzyme activity.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      We identified 11 patients who underwent a total of 33 desensitizations to pegaspargase and calaspargase pegol\u2010mknl. No patients experienced clinically significant hypersensitivity reactions necessitating stopping the infusion, nor administration of rescue medications. All serum asparaginase activity levels collected demonstrated enzyme activity levels above predefined therapeutic thresholds. Cost analysis revealed substantial savings when patients received asparaginase desensitization over the now commercially available asparaginase\n                      <jats:italic>E. chrysanthemi<\/jats:italic>\n                      (recombinant) rywn.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Performing desensitization to pegaspargase in the pediatric acute lymphoblastic leukemia population is feasible, safe, and effective. It is financially advantageous over available alternative approaches, and requires fewer injections and presentations to care.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/pbc.30891","type":"journal-article","created":{"date-parts":[[2024,2,4]],"date-time":"2024-02-04T23:33:28Z","timestamp":1707089608000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Desensitization using pegaspargase in the era of commercially available\n                    <i>Erwinia<\/i>\n                    : A single\u2010institution report on efficacy, cost, and resource utilization"],"prefix":"10.1002","volume":"71","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-9237-8435","authenticated-orcid":false,"given":"Kira","family":"Feldman","sequence":"first","affiliation":[{"name":"San Francisco Department of Pediatrics University of California  San Francisco California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kathryn","family":"Aaronson","sequence":"additional","affiliation":[{"name":"Division of Pediatric Oncology University of California San Francisco Benioff Children's Hospital  San Francisco California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5261-4990","authenticated-orcid":false,"given":"Tina","family":"Gu","sequence":"additional","affiliation":[{"name":"Department of Pharmacy University of California San Francisco California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7411-3508","authenticated-orcid":false,"given":"Kelsey","family":"Ige","sequence":"additional","affiliation":[{"name":"Division of Pediatric Immunology University of California San Francisco Benioff Children's Hospital  San Francisco California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erica","family":"Southworth","sequence":"additional","affiliation":[{"name":"Division of Pediatric Oncology University of California San Francisco Benioff Children's Hospital  San Francisco California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lauren","family":"Sanchez","sequence":"additional","affiliation":[{"name":"Division of Pediatric Immunology University of California San Francisco Benioff Children's Hospital  San Francisco California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7032-4623","authenticated-orcid":false,"given":"Elliot","family":"Stieglitz","sequence":"additional","affiliation":[{"name":"Division of Pediatric Oncology University of California San Francisco Benioff Children's Hospital  San Francisco California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2024,2,4]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra1400972"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1182\/blood\u20102013\u201010\u2010534347"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2014.55.5763"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1080\/08880018.2019.1634778"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2012.43.2070"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1080\/10428194.2017.1386305"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10238\u2010008\u20100026\u20109"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1182\/blood\u20102013\u201001\u2010480822"},{"key":"e_1_2_9_10_1","unstructured":"Common Terminology Criteria for Adverse Events (CTCAE): protocol development.CTEP. Accessed January 25 2023.https:\/\/ctep.cancer.gov\/protocoldevelopment\/electronic_applications\/ctc.htm"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaip.2017.04.033"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.3324\/haematol.2015.137380"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.1038\/leu.2008.165"},{"key":"e_1_2_9_14_1","unstructured":"Pegspargase. Lexi\u2010drugs.UpToDate Inc.; July 31 2023. Accessed September 9 2023.http:\/\/online.lexi.com\/"},{"key":"e_1_2_9_15_1","unstructured":"Calaspargase pegol. Lexi\u2010drugs.UpToDate Inc.; June 37 2023. Accessed September 9 2023.http:\/\/online.lexi.com\/"},{"key":"e_1_2_9_16_1","unstructured":"Asparaginase (Erwinia[recombinant]). Lexi\u2010drugs.UpToDate Inc.; July 18 2023. Accessed September 9 2023.http:\/\/online.lexi.com\/"},{"key":"e_1_2_9_17_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.19.03024"},{"key":"e_1_2_9_18_1","doi-asserted-by":"publisher","DOI":"10.3389\/fped.2022.902117"},{"key":"e_1_2_9_19_1","doi-asserted-by":"publisher","DOI":"10.1182\/blood.2020006583"},{"key":"e_1_2_9_20_1","doi-asserted-by":"publisher","DOI":"10.2174\/157488606777934413"},{"key":"e_1_2_9_21_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00262\u2010012\u20101273\u2010x"},{"key":"e_1_2_9_22_1","doi-asserted-by":"publisher","DOI":"10.1182\/blood.2019003407"},{"key":"e_1_2_9_23_1","doi-asserted-by":"publisher","DOI":"10.1002\/pbc.28021"},{"key":"e_1_2_9_24_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.anai.2019.11.001"},{"key":"e_1_2_9_25_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamapediatrics.2021.5767"}],"container-title":["Pediatric Blood &amp; Cancer"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/pbc.30891","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/pbc.30891","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/pbc.30891","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,16]],"date-time":"2026-03-16T06:35:58Z","timestamp":1773642958000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/pbc.30891"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,2,4]]},"references-count":24,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2024,4]]}},"alternative-id":["10.1002\/pbc.30891"],"URL":"https:\/\/doi.org\/10.1002\/pbc.30891","archive":["Portico"],"relation":{},"ISSN":["1545-5009","1545-5017"],"issn-type":[{"value":"1545-5009","type":"print"},{"value":"1545-5017","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,2,4]]},"assertion":[{"value":"2023-06-30","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-01-15","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-02-04","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e30891"}}