Recurrent cerebrovascular accident with L-asparaginase rechallenge.
We report a 15-year-old boy diagnosed with acute lymphoblastic leukemia (ALL) in 1983. Induction therapy included L-asparaginase. After the second dose of L-asparaginase, he had a left sided focal seizure and computed tomography (CT) scan of the head showed a right frontal infarct. No further L-asparaginase was given. Complete remission was achieved and he successfully completed therapy in 1986. Eight months later he had an isolated bone marrow relapse. Reinduction therapy included L-asparaginase. After the fourth dose of L-asparaginase, he presented with severe headache and a CT scan showed a right temporal infarct. Repeat infarction on rechallenge with L-asparaginase has not been previously reported. Prophylactic therapy, such as fresh frozen plasma, should be considered before patients, with a previous cerebral insult, are rechallenged with L-asparaginase. However the effectiveness of such therapy has not been established.
Foreman
N K
NK
Department of Hematology-Oncology, St. Jude Children's Research Hospital, Memphis, TN 38101-0318.
Mahmoud
H H
HH
Rivera
G K
GK
Crist
W M
WM
D000293:Adolescent; D001215:Asparaginase / Q000008:administration & dosage / Q000009:adverse effects*; D002544:Cerebral Infarction / Q000139:chemically induced*; D006801:Humans; D008297:Male; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000188:drug therapy*; D012074:Remission Induction; D012306:Risk
D001215:Asparaginase