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What is an allergic reaction or hypersensitivity reaction?

Review the signs and symptoms of hypersensitivity with patients and caregivers.

Hello, I am nurse Molly. Every day, I work with patients receiving asparaginase therapy for ALL or LBL.

Some patients may experience an allergic reaction to that therapy. The healthcare team may also refer to it as a hypersensitivity reaction.

Both acute lymphoblastic leukemia, or ALL, and lymphoblastic lymphoma, or LBL, are rare cancers of the blood and bone marrow that are most common in children, adolescents, and young adults.

Asparaginase is part of a multiagent therapy for ALL and LBL. Patients with ALL and LBL receive asparaginase therapy derived from E. coli bacteria. Even though it can help fight cancer, it can have unpleasant side effects.

Now let’s talk about:

One, what are allergic reactions to asparaginase therapy?

Two, what are the symptoms of an allergic reaction?

Three, what effect will an allergic reaction have on your cancer treatment?

Four, how are allergic reactions treated?

Five, who should you talk to if you experience an allergic reaction?

Number 1: what are allergic reactions to asparaginase therapy?

During treatment for ALL or LBL, you may experience an allergic reaction to your asparaginase therapy. An allergic reaction is when your body responds to something it doesn't like.

Just like your body may react to dust and pollen, certain foods such as peanuts, or even bee stings, it can also react to medicines meant to treat illness. Asparaginase, which can be derived from E. coli bacteria, can be one of those medicines.

Everyone is unique. Some people have a mild reaction, and some have a worse reaction. As many as 3 out of 10 patients may experience an allergic reaction after E. coli-derived asparaginase therapy.

Number 2: what are the symptoms of an allergic reaction?

Allergic reactions can make people feel sick. Some common symptoms that people with allergic reactions experience are itching, swelling of the mouth or skin, hives, headache, watery eyes, trouble breathing, vomiting, stomach cramps, or drop in blood pressure.

Most reactions to asparaginase happen quickly, but some reactions can occur up to 6 hours later.

Number 3: what effect will an allergic reaction have on your cancer treatment?

Experiencing an allergic reaction can mean that your current asparaginase therapy is not working as it should. Being treated again with the same type of asparaginase therapy that triggered an allergic reaction the first time can cause a similar or even worse response.

Number 4: how are allergic reactions treated?

Seek medical advice immediately if symptoms of an allergic reaction occur.

If you experience an allergic reaction to E. coli-derived asparaginase, your doctor and care team will decide whether to switch to a different type of asparaginase therapy—one that isn’t derived from E. coli. They will determine if switching to a different type can help ensure that your asparaginase therapy works correctly. This change also allows most patients to finish asparaginase therapy as the doctor intended.

A different type of asparaginase therapy derived from Erwinia chrysanthemi can have the same effect on your cancer as asparaginase derived from E. coli. Like E. coli-derived asparaginase, Erwinia-derived asparaginase may cause allergic reactions. Alert the healthcare team immediately if symptoms of an allergic reaction occur.

This different type of asparaginase therapy is short-acting, which means it is given more frequently to help ensure patients can maintain effective levels of asparaginase in their blood.

Number 5: who should you talk to if you experience an allergic reaction?

If you experience symptoms of an allergic reaction, alert your care team immediately and talk about a different type of asparaginase therapy. They can address your questions or concerns and support you in making the best decision for you.

Indication

RYLAZE is indicated as a component of a multi-agent chemotherapeutic regimen given by intramuscular injection for the treatment of acute lymphoblastic leukemia (ALL) and lymphoblastic lymphoma (LBL) in adult and pediatric patients 1 month or older who have developed hypersensitivity to E. coli-derived asparaginase.

IMPORTANT SAFETY INFORMATION

Contraindications

RYLAZE is contraindicated in patients with a history of:

  • Serious hypersensitivity reactions to Erwinia asparaginase, including anaphylaxis
  • Serious pancreatitis during previous asparaginase therapy
  • Serious thrombosis during previous asparaginase therapy
  • Serious hemorrhagic events during previous asparaginase therapy

Warnings and Precautions

Hypersensitivity Reactions

Hypersensitivity reactions after the use of RYLAZE occurred in 29% of patients in clinical trials, and it was severe in 6% of patients. Anaphylaxis was observed in 2% of patients after intramuscular administration. Discontinuation of RYLAZE due to hypersensitivity reactions occurred in 5% of patients. Hypersensitivity reactions were higher in patients who received intravenous asparaginase erwinia chrysanthemi (recombinant)-rywn. The intravenous route of administration is not approved.

In patients administered RYLAZE intramuscularly in clinical trials, the median number of doses of RYLAZE that patients received prior to the onset of the first hypersensitivity reaction was 12 doses (range: 1-64 doses). The most commonly observed reaction was rash (19%), and 1 patient (1%) experienced a severe rash.

Hypersensitivity reactions observed with L-asparaginase class products include angioedema, urticaria, lip swelling, eye swelling, rash or erythema, blood pressure decreased, bronchospasm, dyspnea, and pruritus.

Premedicate patients prior to administration of RYLAZE as recommended. Because of the risk of serious allergic reactions (e.g., life-threatening anaphylaxis), administer RYLAZE in a setting with resuscitation equipment and other agents necessary to treat anaphylaxis (e.g., epinephrine, oxygen, intravenous steroids, antihistamines). Discontinue RYLAZE in patients with serious hypersensitivity reactions.

Pancreatitis

Pancreatitis, including elevated amylase or lipase, was reported in 20% of patients in clinical trials of RYLAZE and was severe in 8%. Symptomatic pancreatitis occurred in 7% of patients, and it was severe in 6% of patients. Elevated amylase or lipase without symptomatic pancreatitis was observed in 13% of patients treated with RYLAZE. Hemorrhagic or necrotizing pancreatitis have been reported with L-asparaginase class products.

Inform patients of the signs and symptoms of pancreatitis, which, if left untreated, could be fatal. Evaluate patients with symptoms compatible with pancreatitis to establish a diagnosis. Assess serum amylase and lipase levels in patients with any signs or symptoms of pancreatitis. Discontinue RYLAZE in patients with severe or hemorrhagic pancreatitis. In the case of mild pancreatitis, withhold RYLAZE until the signs and symptoms subside and amylase and/or lipase levels return to 1.5 times the ULN. After resolution of mild pancreatitis, treatment with RYLAZE may be resumed.

Thrombosis

Serious thrombotic events, including sagittal sinus thrombosis and pulmonary embolism, have been reported in 1% of patients following treatment with RYLAZE. Discontinue RYLAZE for a thrombotic event, and administer appropriate antithrombotic therapy. Consider resumption of treatment with RYLAZE only if the patient had an uncomplicated thrombosis.

Hemorrhage

Bleeding was reported in 25% of patients treated with RYLAZE, and it was severe in 2%. Most commonly observed reactions were bruising (12%) and nose bleed (9%).

In patients treated with L-asparaginase class products, hemorrhage may be associated with increased prothrombin time (PT), increased partial thromboplastin time (PTT), and hypofibrinogenemia. Consider appropriate replacement therapy in patients with severe or symptomatic coagulopathy.

Hepatotoxicity

Elevated bilirubin and/or transaminases occurred in 75% of patients treated with RYLAZE in clinical trials, and 26% had Grade ≥3 elevations. Elevated bilirubin occurred in 28% of patients treated with RYLAZE in clinical trials, and 2% had Grade ≥3 elevations. Elevated transaminases occurred in 73% of patients treated with RYLAZE in clinical trials, and 25% had Grade ≥3 elevations.

Inform patients of the signs and symptoms of hepatotoxicity. Evaluate bilirubin and transaminases prior to treatment every 2-3 weeks and as indicated clinically during treatment with RYLAZE. In the event of serious liver toxicity, discontinue treatment with RYLAZE and provide supportive care.

Adverse Reactions

The most common adverse reactions (incidence >20%) with RYLAZE are abnormal liver test, nausea, musculoskeletal pain, infection, fatigue, headache, febrile neutropenia, pyrexia, hemorrhage, stomatitis, abdominal pain, decreased appetite, drug hypersensitivity, hyperglycemia, diarrhea, pancreatitis, and hypokalemia.

Use in Specific Populations

Pregnancy and Lactation

RYLAZE can cause fetal harm when administered to a pregnant woman. Advise females of reproductive potential to use effective non-hormonal contraceptive methods during treatment with RYLAZE and for 3 months after the last dose. Advise women not to breastfeed during treatment with RYLAZE and for 1 week after the last dose.

Please see full Prescribing Information.

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Indication

RYLAZE is indicated as a component of a multi-agent chemotherapeutic regimen given by intramuscular injection for the treatment of acute lymphoblastic leukemia (ALL) and lymphoblastic lymphoma (LBL) in adult and pediatric patients 1 month or older who have developed hypersensitivity to E. coli-derived asparaginase.

IMPORTANT SAFETY INFORMATION

IMPORTANT SAFETY 
INFORMATION AND INDICATION

Contraindications

RYLAZE is contraindicated in patients with a history of:

  • Serious hypersensitivity reactions to Erwinia asparaginase, including anaphylaxis
  • Serious pancreatitis during previous asparaginase therapy
  • Serious thrombosis during previous asparaginase therapy
  • Serious hemorrhagic events during previous asparaginase therapy