Silent hypersensitivity to Escherichia coli asparaginase in children with acute lymphoblastic leukemia.
This prospective study aimed to assess the incidence of silent hypersensitivity to Escherichia coli asparaginase in the treatment of acute lymphoblastic leukemia (ALL). Thirty-three children with newly diagnosed ALL were included in the study and treated according to the FRALLE 2000 protocol. The 'A group' (n = 18) differed from the 'B-T group' (n = 15) by a less intensive chemotherapy, the absence of concurrent prednisone therapy, and different asparaginase administration modalities during the second intensification. Asparagine, asparaginase activity, and anti-asparaginase antibodies were measured in each phase before the next injection of asparaginase. Eighteen percent of children presented a silent hypersensitivity. Most of them were in the 'B-T group' (p = 0.07), and maintained low antibody titers throughout the treatment. Clinical hypersensitivity was statistically more frequent in group A (p = 0.002), and allergy occurred mainly during the second intensification when antibody concentrations were significantly increased. We did not find any significant difference between asparaginase activity or asparagine depletion between the silent hypersensitivity and clinical allergy groups. In all, the results of this study suggest that chemotherapy and corticosteroid therapy associated with asparaginase treatment can lower antibody production and contribute to maintaining a silent hypersensitivity state.
Strullu
Marion
M
Service d'Onco-Hématologie Pédiatrique, CHU de Nantes, Hopital Mère-Enfant, Nantes, France.
Corradini
Nadège
N
Audrain
Marie
M
Orsonneau
Jean-Luc
JL
Bouige
Daniel
D
Thomare
Patrick
P
Vermot-Desroches
Claudine
C
Mansuy
Adeline
A
Legrand
Arnaud
A
Rozé
Jean-Christophe
JC
Mohty
Mohamad
M
Méchinaud
Françoise
F
D000293:Adolescent; D000888:Antibodies, Anti-Idiotypic / Q000276:immunology / Q000378:metabolism; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D001215:Asparaginase / Q000009:adverse effects* / Q000276:immunology; D001216:Asparagine / Q000378:metabolism; D002648:Child; D002675:Child, Preschool; D004342:Drug Hypersensitivity; D004797:Enzyme-Linked Immunosorbent Assay; D004926:Escherichia coli / Q000201:enzymology*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy*; D011379:Prognosis; D011446:Prospective Studies; D015996:Survival Rate
D000888:Antibodies, Anti-Idiotypic; D000970:Antineoplastic Agents; D001216:Asparagine; D001215:Asparaginase