A desensitization protocol in children with L-asparaginase hypersensitivity.

Abstract

BACKGROUND:

L-asparaginase is effective in the treatment of malignant diseases, but it has been associated with hypersensitivity reactions in 5% to 45% of the patients.

PURPOSE:

To determine whether a desensitization protocol in children with native Escherichia coli L-asparaginase hypersensitivity allows subsequent safe administration of native E. coli L-asparaginase.

PATIENTS AND METHODS:

A desensitization protocol was used in 9 children with leukemia (n=8) or Langerhans cell histiocytosis (n=1) and previous severe (n=4) or mild/moderate (n=5) L-asparaginase hypersensitivity. Dexamethasone (2 mg/kg intravenously) and pheniramine hydrogen maleate (1 mg/kg intravenously) were administered 1 hour before each of the following L-asparaginase administrations. Subsequently, 0.1%, 1%, 5%, 10%, and the remaining 84% of the total dose of L-asparaginase (10,000 IU/m2) were each prepared in 240 mL 0.9% saline and infused over 4 hours (20 h in total).

RESULTS:

After desensitization, none of the patients had recurrence of hypersensitivity reactions during the subsequent 2 to 15 doses (median: 6 doses/patient; 68 doses in total) of native E. coli L-asparaginase.

CONCLUSION:

This desensitization protocol was safe and allows continued administration of native E. coli L-asparaginase administration.

• Authors: Sinan Akbayram, Murat Doğan, Cihangir Akgün, Hüseyin Caksen, Ahmet Faik Oner
• Journal: Journal of pediatric hematology/oncology (J Pediatr Hematol Oncol) Vol. 32 Issue 5 Pg. e187-91 (Jul 2010) ISSN: 1536-3678 [Electronic] United States
• PMID: 20505537 (Publication Type: Journal Article)

Chemical References

• Antineoplastic Agents
• Asparaginase

Topics

• Adolescent
• Antineoplastic Agents (adverse effects)
• Asparaginase (adverse effects)
• Child
• Child, Preschool
• Desensitization, Immunologic
• Drug Hypersensitivity (etiology)
• Escherichia coli (enzymology)
• Female
• Histiocytosis, Langerhans-Cell (drug therapy)
• Humans
• Infant
• Male
• Precursor Cell Lymphoblastic Leukemia-Lymphoma (drug therapy)
• Remission Induction
• Survival Rate
• Treatment Outcome