소아 급성림프구성백혈병 치료에서 L-asparaginase의skin test 시행 방법의 적절성 평가
Comparison of L-Asparaginase Skin Test According to Test Interval in the Treatment of Pediatric Acute Lymphoblastic Leukemia
1
조회
0
다운로드
1
인용
0
참고문헌
키워드
초록
Background and Objective : L-asparaginase is the chemotherapeutic agent for the treatment of acute lymphoblastic leukemia and is associated with hypersensitivity reactions. Because of the high rates of hypersensitivity reactions, skin test has been proposed. However, the method of skin test not standardized, and false-positive and false-negative results have been documented. We have conducted skin tests prior to every dose of L-asparaginase. In consideration of the convenience of administration, the skin test is changed to be conducted prior to the first dose of L-asparaginase and prior to restarting therapy after an interval of a week or more has elapsed between doses by intervention of a pediatric oncology pharmacist. The objective of this study was to evaluate the sensitivity and specificity of skin tests. Methods : From July-December 2012, patients that received skin tests prior to every dose of Lasparaginase were classified A group. From July-December 2013, patients that received skin tests prior to the first dose of L-asparaginase and prior to restarting therapy after an interval of a week or more has elapsed between doses were classified B group. Results : 63 patients were included in the A group and received 402 cases of skin tests. 65 patients were included in the B group and received 126 cases of skin tests. The sensitivity of skin tests in the B group (52.2%) was superior to the A group (20%). This result showed statistically significant difference (p=0.047). The specificity of skin tests in the A group (96.1%) was superior to the B group (90.3%). This result showed statistically significant difference (p=0.017). Conclusion : In conclusion, reducing the number of skin tests by intervention of a pediatric oncology pharmacist improved convenience of administration and enhanced clinical safety of chemotherapy.
Abstract
Background and Objective : L-asparaginase is the chemotherapeutic agent for the treatment of acute lymphoblastic leukemia and is associated with hypersensitivity reactions. Because of the high rates of hypersensitivity reactions, skin test has been proposed. However, the method of skin test not standardized, and false-positive and false-negative results have been documented. We have conducted skin tests prior to every dose of L-asparaginase. In consideration of the convenience of administration, the skin test is changed to be conducted prior to the first dose of L-asparaginase and prior to restarting therapy after an interval of a week or more has elapsed between doses by intervention of a pediatric oncology pharmacist. The objective of this study was to evaluate the sensitivity and specificity of skin tests. Methods : From July-December 2012, patients that received skin tests prior to every dose of Lasparaginase were classified A group. From July-December 2013, patients that received skin tests prior to the first dose of L-asparaginase and prior to restarting therapy after an interval of a week or more has elapsed between doses were classified B group. Results : 63 patients were included in the A group and received 402 cases of skin tests. 65 patients were included in the B group and received 126 cases of skin tests. The sensitivity of skin tests in the B group (52.2%) was superior to the A group (20%). This result showed statistically significant difference (p=0.047). The specificity of skin tests in the A group (96.1%) was superior to the B group (90.3%). This result showed statistically significant difference (p=0.017). Conclusion : In conclusion, reducing the number of skin tests by intervention of a pediatric oncology pharmacist improved convenience of administration and enhanced clinical safety of chemotherapy.
참고문헌 (19)
- Capizzi RL, "L-Asparaginase: Clinical, Biochemical, Pharmacological, and Immunological Studies", Ann Intern Med, 74(6), pp.893~902 (1971)[DOI]
- Billett AL, "Allergic reactions to Erwinia asparaginase in children with acute lymphoblastic leukemia who had previous allergic reactions to escherichia coli asparaginase", Cancer, 70(1), pp.201~206 (1992)[DOI]
- Woo MH, "Anti-asparaginase antibodies following E. coli asparaginase therapy in pediatric acute lymphoblastic leukemia", Leukemia, 12(10), pp.1527~1533 (1998)[DOI]
- Khan A, "Atopic hypersensitivity to L-Asparaginase", Int Arch Allergy, 40(3), pp.463~469 (1971)[DOI]
- Fabry U, "Anaphylaxis to L-asparaginase during treatment for acute lymphoblastic leukemia in children--evidence of a complement-mediated mechanism", Pediatr Res, 19(4), pp.400~408 (1985)[DOI]
- Christina L, "Diagnosis and management of hypersensitivity reactions related to common cancer chemotherapy agents", Ann Allergy Asthma Immunol, 102(3), pp.179~187 (2009)[DOI]
- Zanotti K, "Prevention and Management of Antineoplastic-Induced Hypersensitivity Reactions", Drug Safety, 24(10), pp.767~779 (2001)[DOI]
- "AHFS Drug Information Essentials", ~ (2013)
- Evans WE, "Anaphylactoid reactions to Escherichia coli and Erwinia asparaginase in children with leukemia and lymphoma", Cancer, 49(7), pp.1378~1383 (1982)[DOI]
- Shepherd GM, "Hypersensitivity Reactions to Chemotherapeutic Drugs", Clin Rev Allergy Immunol, 24(3), pp.253~262 (2003)[DOI]
- Nesbit M, "Evaluation of intramuscular versus intravenous administration of L-asparaginase in childhood leukemia", Am J Pediatr Hematol Oncol, 1(1), pp.9~13 (1979)
- Weiss RB, "Hypersensitivity reactions", Semin Oncol, 19(5), pp.458~477 (1992)
- Inge MS, "Consensus expert recommendations for identification and management of asparaginase hypersensitivity and silent inactivation", Haematologica, 101(3), pp.279~285 (2016)[DOI]
- Rachel AE, "L-asparaginase in the treatment of patients with acute lymphoblastic leukemia", J Pharmacol Pharmacother, 7(2), pp.62~71 (2016)[DOI]
- Sara ES, "Managing hypersensitivity to asparaginase in pediatrics, adolescents, and young adults", J Pediatr Oncol Nurs, 30(2), pp.63~77 (2013)[DOI]
- Takahashi H, "The feasibility of Erwinia asparaginase for pediatric patients who developed an allergic reaction to E.coli asparaginase during treatment of acute lymphoblastic leukemia", JPN J clin oncol, 54(4), pp.370~377 (2013)
- Stock W, "Prevention and management of asparaginase", pegasparaginase-associated toxicities in adults and older adolescents: recommendations of an expert panel, 2011, pp.52(12), 2237~2253
- Ozge US, "Alternative algorithm for L-asparaginase allergy in children with acute lymphoblastic leukemia", J Allergy Clin Immunol, 123(4), pp.895~899 (2009)[DOI]
- Akbayram S, "A desensitization protocol in children with L-asparaginase hypersensitivity", J Pediatr Hematol Oncol, 32(5), pp.187~191 (2010)[DOI]