L-asparaginase와 PEG-L-asparaginase를 투여한 소아 급성 림프구성 백혈병 치료시 부작용 비교

Abstract

L-asparaginase (L-asp) is an essential drug for the treatment of acute lymphoblastic leukemia (ALL). However, it requires attention for several side effects. PEG-L-asparaginase (PEG-L-asp), which is formed by the covalent linkage of L-asp to polyethylene glycol (PEG), is also not safe from side effects. In this study, we considered 6 side effects (hypersensitivity, acute pancreatitis, coagulopathy, hyperglycemia, hepatotoxicity and elevation of blood ammonia levels) from 60 pediatric ALL patients who received L-asp and PEG-L-asp in severance hospitals between 2006 and 2010. Among them, 22 patients received only L-asp, and 38 patients were converted from L-asp to PEG-L-asp. Differences were evaluated by the chi-square test and Fisher exact test on the SAS software (version 9.2). Elevation of blood ammonia levels (P=0.0050), hypersensitivity (P=0.1219), bleeding risk (P=0.2839), and hyperglycemia (P=0.6194) were more frequent in the L-asp group. Hepatotoxicity (P=0.1968), thromboembolism (P=0.6432), and acute pancreatitis (P=0.7321) were more frequent in the PEG-L-asp group. The incidence for each side effect depends not only on the drug itself, but also on the patients’risk, treatment phase and so on. Hypersensitivity by treatment phase (P=0.0109) and bleeding tendency by patients’risk (P=0.0057) show statistical differences. Through this study, we would like to obtain supportive evidence and contribute to the safe consumption of drugs for children with ALL.