소아 급성 림프구성 백혈병 환자에서 치료 변경을 요하는 L-asparaginase 과민반응 발생률 및 관련 인자
Incidence and Related Factors of L-asparaginase-induced Hypersensitivity Reactions Requiring Treatment Changes in Pediatric Patients with Acute Lymphoblastic Leukemia
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Background : Asparaginase is an important therapeutic agent in pediatric patients with acute lymphoblastic leukemia (ALL), but asparaginase-induced hypersensitivity reaction is one of the barriers to treatment completion. However, there have been limited studies investigating asparaginase-induced hypersensitivities in pediatric patients. The aim of this study was to investigate the incidence proportion and related factors of asparaginase- induced hypersensitivity reactions requiring treatment modification among pediatric patients with ALL. Methods : This cross-sectional study analyzed the pediatric ALL patients who received asparaginase treatment according to an in-hospital protocol between 2004-2021 at a single institution. The study calculated incidence proportions and treatment changes due to hypersensitivity reactions to different types of L-asparaginase. Risk factors of hypersensitivity were identified using generalized estimation equations. Results : Among the 269 eligible patients, 73 patients (27.1%) discontinued native E.coli asparaginase due to hypersensitivity. Hypersensitivity was observed with positive prior skin test before administration in 64 patients (23.8%) and allergic reaction after administration in 9 patients (3.3%). All of these patients switched to Erwina asparaginase but 10 patients (13.7%) among them showed hypersensitivity reactions to Erwina asparaginase. The related factors of asparaginase-induced hypersensitivity were identified as consolidation stage (odds ratio (OR) 14.70, 95% CI 1.70 – 126.99), long administration interval (OR 1.02, 95% CI 1.00 – 1.03), and high risk group for ALL (OR 3.35, 95% CI 1.21 – 9.27). Conclusion : The incidence proportion of hypersensitivity requiring treatment modification to Erwina asparaginase in pediatric patients was approximately 27%, and hypersensitivity reactions occurred in approximately 14% of patients after change to Erwina asparaginase. Consolidation stage, long administration interval, and high risk group for ALL were identified as related factors. Therefore, monitoring hypersensitivity reactions after asparaginase administration should be strengthened.
Abstract
Background : Asparaginase is an important therapeutic agent in pediatric patients with acute lymphoblastic leukemia (ALL), but asparaginase-induced hypersensitivity reaction is one of the barriers to treatment completion. However, there have been limited studies investigating asparaginase-induced hypersensitivities in pediatric patients. The aim of this study was to investigate the incidence proportion and related factors of asparaginase- induced hypersensitivity reactions requiring treatment modification among pediatric patients with ALL. Methods : This cross-sectional study analyzed the pediatric ALL patients who received asparaginase treatment according to an in-hospital protocol between 2004-2021 at a single institution. The study calculated incidence proportions and treatment changes due to hypersensitivity reactions to different types of L-asparaginase. Risk factors of hypersensitivity were identified using generalized estimation equations. Results : Among the 269 eligible patients, 73 patients (27.1%) discontinued native E.coli asparaginase due to hypersensitivity. Hypersensitivity was observed with positive prior skin test before administration in 64 patients (23.8%) and allergic reaction after administration in 9 patients (3.3%). All of these patients switched to Erwina asparaginase but 10 patients (13.7%) among them showed hypersensitivity reactions to Erwina asparaginase. The related factors of asparaginase-induced hypersensitivity were identified as consolidation stage (odds ratio (OR) 14.70, 95% CI 1.70 – 126.99), long administration interval (OR 1.02, 95% CI 1.00 – 1.03), and high risk group for ALL (OR 3.35, 95% CI 1.21 – 9.27). Conclusion : The incidence proportion of hypersensitivity requiring treatment modification to Erwina asparaginase in pediatric patients was approximately 27%, and hypersensitivity reactions occurred in approximately 14% of patients after change to Erwina asparaginase. Consolidation stage, long administration interval, and high risk group for ALL were identified as related factors. Therefore, monitoring hypersensitivity reactions after asparaginase administration should be strengthened.
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