{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,2]],"date-time":"2026-05-02T12:23:21Z","timestamp":1777724601129,"version":"3.51.4"},"reference-count":20,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2025,11,17]],"date-time":"2025-11-17T00:00:00Z","timestamp":1763337600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Clinics and Practice"],"abstract":"<jats:p>Background\/Objectives: Asparaginase (ASP)-based chemotherapy has substantially improved clinical outcomes in Epstein\u2013Barr virus (EBV)-positive NK\/T-cell lymphomas (NKTCL). However, as a bacterial-derived enzyme, ASP is frequently associated with immune-mediated adverse events, particularly hypersensitivity reactions (HSRs), which may compromise both treatment efficacy and patient safety. This report presents a case of an ASP-related HSR and reviews the incidence within our institutional cohort. Detailed Case Description: A 60-year-old female presented an immediate Grade 2 HSR during her second PEG-asparaginase infusion, with pruritus, vomiting, and presyncope. The infusion was discontinued, and she was subsequently transitioned to crisantaspase\u2014an alternative formulation\u2014which was well tolerated without further adverse events. She remains disease-free to date. A retrospective review of institutional records (2015\u20132025) identified six patients with NKTCL treated with ASP-containing chemotherapy. The incidence of HSRs in this cohort was 1 of 6 (16.7%). Conclusions: As in acute lymphoblastic leukemia, HSRs to asparaginase remains a major challenge in the management of NKTCL with potential implications for treatment safety and efficacy. The establishment of standardized, consensus-based criteria for the diagnosis, classification, and management of ASP-related HSRs is urgently needed to optimize patient outcomes.<\/jats:p>","DOI":"10.3390\/clinpract15110211","type":"journal-article","created":{"date-parts":[[2025,11,17]],"date-time":"2025-11-17T14:04:07Z","timestamp":1763388247000},"page":"211","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Asparaginase Hypersensitivity Reactions in NK\/T-Cell Lymphomas"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-9606-4405","authenticated-orcid":false,"given":"Javier","family":"Varela Gonzalez-Aller","sequence":"first","affiliation":[{"name":"Pharmacy Department, Catalan Institute of Oncology, L\u2019Hospitalet de Llobregat, 08908 Barcelona, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-0202-7600","authenticated-orcid":false,"given":"Pablo","family":"Nadal","sequence":"additional","affiliation":[{"name":"Pharmacy Department, Catalan Institute of Oncology, L\u2019Hospitalet de Llobregat, 08908 Barcelona, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Salome","family":"Ca\u00f1izares","sequence":"additional","affiliation":[{"name":"Pharmacy Department, Catalan Institute of Oncology, L\u2019Hospitalet de Llobregat, 08908 Barcelona, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Carmen","family":"Mu\u00f1oz","sequence":"additional","affiliation":[{"name":"Pharmacy Department, Catalan Institute of Oncology, L\u2019Hospitalet de Llobregat, 08908 Barcelona, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anna","family":"Valer","sequence":"additional","affiliation":[{"name":"Hematology Department, Institut Catal\u00e0 d\u2019Oncologia, L\u2019Hospitalet de Llobregat, 08908 Barcelona, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1323-1508","authenticated-orcid":false,"given":"Eva","family":"Gonzalez-Barca","sequence":"additional","affiliation":[{"name":"Hematology Department, Institut Catal\u00e0 d\u2019Oncologia, L\u2019Hospitalet de Llobregat, 08908 Barcelona, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8907-090X","authenticated-orcid":false,"given":"Eva","family":"Domingo","sequence":"additional","affiliation":[{"name":"Hematology Department, Institut Catal\u00e0 d\u2019Oncologia, L\u2019Hospitalet de Llobregat, 08908 Barcelona, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1238-6970","authenticated-orcid":false,"given":"Ana","family":"Sureda","sequence":"additional","affiliation":[{"name":"Hematology Department, Institut Catal\u00e0 d\u2019Oncologia, L\u2019Hospitalet de Llobregat, 08908 Barcelona, Spain"},{"name":"Bellvitge Biomedical Research Institute (IDIBELL), L\u2019Hospitalet de Llobregat, 08908 Barcelona, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8750-0195","authenticated-orcid":false,"given":"Silvana","family":"Novelli","sequence":"additional","affiliation":[{"name":"Hematology Department, Institut Catal\u00e0 d\u2019Oncologia, L\u2019Hospitalet de Llobregat, 08908 Barcelona, Spain"},{"name":"Bellvitge Biomedical Research Institute (IDIBELL), L\u2019Hospitalet de Llobregat, 08908 Barcelona, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,11,17]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1720","DOI":"10.1038\/s41375-022-01620-2","article-title":"The 5th edition of the World Health Organization Classification of Haematolymphoid Tumours: Lymphoid Neoplasms","volume":"36","author":"Alaggio","year":"2022","journal-title":"Leukemia"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"514","DOI":"10.1007\/s11899-016-0355-9","article-title":"Extranodal NK\/T Cell Lymphoma, Nasal Type (ENKTL-NT): An Update on Epidemiology, Clinical Presentation, and Natural History in North American and European Cases","volume":"11","author":"Haverkos","year":"2016","journal-title":"Curr. Hematol. Malign Rep."},{"key":"ref_3","first-page":"1320","article-title":"Epidemiology of mature T\/NK-cell lymphomas in Germany\u2014A representative cross-sectional study based on SHI claims data","volume":"21","author":"Assaf","year":"2023","journal-title":"J. Der Dtsch. Dermatol. Ges."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"314","DOI":"10.4143\/crt.2022.015","article-title":"A New Prognostic Index for Extranodal Natural Killer\/T-Cell Lymphoma:Incorporation of Serum \u03b2-2 Microglobulin to PINK","volume":"55","author":"Kang","year":"2023","journal-title":"Cancer Res. Treat."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"2351","DOI":"10.1002\/1097-0142(19951201)76:11<2351::AID-CNCR2820761125>3.0.CO;2-1","article-title":"Frequent expression of P-glycoprotein\/MDR1 by nasal T-cell lymphoma cells","volume":"76","author":"Yamaguchi","year":"1995","journal-title":"Cancer"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"860","DOI":"10.1111\/j.1365-2141.2005.05694.x","article-title":"Selective apoptosis of natural killer-cell tumours by l-asparaginase","volume":"130","author":"Ando","year":"2005","journal-title":"Br. J. Haematol."},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Yan, Z., Yao, S., Wang, Z., Zhou, W., Yao, Z., and Liu, Y. (2023). Treatment of extranodal NK\/T-cell lymphoma: From past to future. Front. Immunol., 14.","DOI":"10.3389\/fimmu.2023.1088685"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"583050","DOI":"10.3389\/fonc.2020.583050","article-title":"Treatment, Survival, and Prognosis of Advanced-Stage Natural Killer\/T-Cell Lymphoma: An Analysis From the China Lymphoma Collaborative Group","volume":"10","author":"Liu","year":"2021","journal-title":"Front. Oncol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"6605","DOI":"10.2147\/OTT.S155930","article-title":"Asparagine synthetase expression is associated with the sensitivity to asparaginase in extranodal natural killer\/T-cell lymphoma in vivo and in vitro","volume":"11","author":"Liu","year":"2018","journal-title":"Onco Targets Ther."},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Curran, E., Luskin, M.R., Alachkar, H., Aldoss, I., Burke, P.W., Cassaday, R.D., Karol, S.E., Perissinotti, A.J., Rank, C.U., and Schmiegelow, K. (2025). Recognition, prevention, and management of adverse events associated with asparaginase\/pegaspargase treatment of acute lymphoblastic leukemia in adults: Consensus of an expert panel. Haematologica.","DOI":"10.3324\/haematol.2024.286744"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"540","DOI":"10.1080\/10428194.2016.1213826","article-title":"Differentiating hypersensitivity versus infusion-related reactions in pediatric patients receiving intravenous asparaginase therapy for acute lymphoblastic leukemia","volume":"58","author":"Burke","year":"2016","journal-title":"Leuk. Lymphoma"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"776","DOI":"10.1080\/10428194.2023.2171267","article-title":"Asparaginase therapy in patients with acute lymphoblastic leukemia: Expert opinion on use and toxicity management","volume":"64","author":"Sandley","year":"2023","journal-title":"Leuk. Lymphoma"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1285","DOI":"10.2217\/fon-2021-1288","article-title":"Hypersensitivity Reactions to Asparaginase Therapy in Acute Lymphoblastic Leukemia: Immunology and Clinical Consequences","volume":"18","author":"Burke","year":"2022","journal-title":"Futur. Oncol."},{"key":"ref_14","first-page":"3155","article-title":"Incidence and Management of Toxicity Associated with LAsparaginase in the Treatment of ALL and NK\/TCell Lymphoma: An Observational Study","volume":"17","author":"Yeang","year":"2016","journal-title":"Asian Pac. J. Cancer Prev."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"176","DOI":"10.1080\/10428194.2020.1824068","article-title":"Tolerability and toxicity of pegaspargase in adults 40 years and older with acute lymphoblastic leukemia","volume":"62","author":"Daley","year":"2020","journal-title":"Leuk. Lymphoma"},{"key":"ref_16","first-page":"99","article-title":"Antibody response to Escherichia coli L-asparaginase. Prognostic significance and clinical utility of antibody measurement","volume":"8","author":"Cheung","year":"1986","journal-title":"Am. J. Pediatr. Hematol. Oncol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"3734","DOI":"10.1182\/blood.V126.23.3734.3734","article-title":"Evaluation of the Impact of the Presence of Neutralizing L-Asparaginase Antibodies on the Efficacy and Safety of Graspa in Phase 3 Randomized Trial Versus Native L-Asparaginase in Patients with Relapsed Acute Lymphoblastic Leukemia (NCT01518517)","volume":"126","author":"Bertrand","year":"2015","journal-title":"Blood"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"2373","DOI":"10.1182\/blood.2020006583","article-title":"Relapse risk following truncation of pegylated asparaginase in childhood acute lymphoblastic leukemia","volume":"137","author":"Grell","year":"2021","journal-title":"Blood"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"439","DOI":"10.1007\/s00280-016-3236-y","article-title":"Asparaginase pharmacology: Challenges still to be faced","volume":"79","year":"2017","journal-title":"Cancer Chemother. Pharmacol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"eabn6491","DOI":"10.1126\/sciadv.abn6491","article-title":"Tumoral microenvironment prevents de novo asparagine biosynthesis in B cell lymphoma, regardless of ASNS expression","volume":"8","author":"Vandenberghe","year":"2022","journal-title":"Sci. Adv."}],"container-title":["Clinics and Practice"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2039-7283\/15\/11\/211\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,11,17]],"date-time":"2025-11-17T14:49:05Z","timestamp":1763390945000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2039-7283\/15\/11\/211"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,11,17]]},"references-count":20,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2025,11]]}},"alternative-id":["clinpract15110211"],"URL":"https:\/\/doi.org\/10.3390\/clinpract15110211","relation":{},"ISSN":["2039-7283"],"issn-type":[{"value":"2039-7283","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,11,17]]}}}