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Premedicating ALL Patients Prior to PEG-Asparaginase Therapy Shows Efficacy and Cost-Effectiveness

August 10, 2021

Acute lymphoblastic leukemia (ALL) is the most common form of cancer affecting children and adolescents. ALL accounts for roughly 25% of malignancies diagnosed during childhood; however, the disease has a high success rate of cure in younger patients, while older adults diagnosed with ALL typically have a worse prognosis.

Treatment of ALL in pediatric patients often involves the use of asparaginase or its long-acting formulation pegylated (PEG)-asparaginase. However, PEG-asparaginase carries with it the potential for toxicities and severe allergic reactions in some patients. 

Substitutions for PEG-asparaginase have been possible, in the past with the recently discontinued agent Erwinia, and now a new recombinant version from the same manufacturer, Jazz Pharmaceuticals, called Rylaze, with comparable efficacy. However, Erwinia had to be administered more frequently with a baseline higher treatment cost and subsequent higher costs due to increased dosing requirements. Erwinia also was is in limited supply globally while it was still being manufactured.

Meghan McCormick, MD, MSUPMC Children’s Hospital of Pittsburgh Division of Pediatric Hematology/Oncology researcher Meghan McCormick, MD, MS, led a recent study examining the use of premedication prior to administration of PEG-asparaginase in pediatric ALL patients as a way to prevent allergic response and the cost-effectiveness of this approach versus the substitute Erwinia therapy.

Dr. McCormick and her colleague's study was published in March in the journal Pediatric Blood & Cancer.

Dr. McCormick's team modeled several treatment scenarios using the premedication and PEG-asparaginase approach versus Erwinia in patient cohorts deemed to be standard risk and high-risk. Premedicating patients before PEG-asparaginase therapy has been shown to be effective in dampening the incidence or severity of allergic reactions, which subsequently require discontinuation of the therapy and a change to a different modality. In fact, the Division of Pediatric Hematology/Oncology at UPMC Children’s has routinely used premedication prior to all doses of PEG-asparaginase.

However, it was unclear whether or not premedication and PEG-asparaginase therapy was a more cost-effective approach to treatment. 

"It is more advantageous for patients and families, in a number of ways, if we can administer and keep them on PEG-asparaginase, and avoid any treatment toxicities that would necessitate discontinuation and a change in therapy to the more laborious approach inherent with Erwina," says Dr. McCormick. "Our modeling shows premedication has the potential to reduce therapy conversions, and it can be done cost-effectively using existing, readily available treatment options and strategies that combine therapeutics with vigilant patient monitoring."

Modeling from the study points to the use of premedication combined with patient monitoring as the more cost-effective approach in both standard risk and high-risk patients, with a corresponding 8% and 7% reduction in therapy conversions, respectively, when compared to using monitoring only with no premedication. 

Further information and full study design details are available at the reference below. 

Learn more about Dr. McCormick.


McCormick M, Lapinski J, Friehling E, Smith K. Premedication Prior to PEG-Asparaginase Is Cost-Effective in Pediatric Patients With Acute Lymphoblastic Leukemia. Pediatr Blood Cancer. 16 April 2021; E29051. Epub ahead of print.