聚乙二醇 - 天冬氨酸酶（pegaspargase）是急性淋巴细胞白血病（ALL）化疗中的关键药物，但接受者常常出现过敏反应。我们假设利妥昔单抗（rituximab）通过减少抗体产生的CD20阳性B细胞，可以减轻这些反应。对St. Jude Total XVII研究中接受新诊断B-ALL治疗的1-18岁的儿童和青少年随机分组，接受诱导治疗，或者不接受利妥昔单抗的治疗，分别在第3天（队列1）或第6天和第24天（队列2）接受。评估患者临床人口统计学特征、CD20表达、最小残余病（MRD）、利妥昔单抗反应、pegaspargase过敏、抗-pegaspargase抗体和胰腺炎。35名患者接受了利妥昔单抗，37名患者未接受。在35名接受者中，有16名（45.7%）对利妥昔单抗出现2级或更高级别的反应。接受者和未接受者在pegaspargase反应（P > 0.999）、抗-pegaspargase抗体（P = 0.327）或胰腺炎（P = 0.480）的发生率上没有差异。利妥昔单抗接受者在第8天的CD20表达明显较低（P < 0.001），但在第8天、第15天或诱导结束时的MRD水平上没有差异。在儿科B-ALL诱导期间接受利妥昔单抗与较高的输注反应发生率相关，但未显著降低pegaspargase过敏、抗-pegaspargase抗体或MRD的发生。 © 2023. 作者，独家授权给Springer Nature Limited。

Polyethylene glycol (PEG)-asparaginase (pegaspargase) is a key agent in chemotherapy for acute lymphoblastic leukemia (ALL), but recipients frequently experience allergic reactions. We hypothesized that by decreasing antibody-producing CD20-positive B cells, rituximab may reduce these reactions. Children and adolescents (aged 1-18 years) with newly diagnosed B-ALL treated on the St. Jude Total XVII study were randomized to induction therapy with or without rituximab on day 3 (cohort 1) or on days 6 and 24 (cohort 2). Patient clinical demographics, CD20 expression, minimal residual disease (MRD), rituximab reactions, pegaspargase allergy, anti-pegaspargase antibodies, and pancreatitis were evaluated. Thirty-five patients received rituximab and 37 did not. Among the 35 recipients, 16 (45.7%) experienced a grade 2 or higher reaction to rituximab. There were no differences between recipients and non-recipients in the incidence of pegaspargase reactions (P  >  0.999), anti-pegaspargase antibodies (P  =  0.327), or pancreatitis (P  =  0.480). CD20 expression on day 8 was significantly lower in rituximab recipients (P  <  0.001), but there were no differences in MRD levels on day 8, 15, or at the end of induction. Rituximab administration during induction in pediatric patients with B-ALL was associated with a high incidence of infusion reactions with no significant decrease in pegaspargase allergies, anti-pegaspargase antibodies, or MRD.© 2023. The Author(s), under exclusive licence to Springer Nature Limited.