title: Delayed-type hypersensitivity in response to L-asparaginase in a case of acute lymphoblastic leukemia.
abstract: L-asparaginase (L-Asp) is an important reagent for acute lymphoblastic leukemia because asparagine is required for the malignant growth of tumor cells, especially lymphoblastic leukemia cells. An allergic response to L-Asp is not unusual because L-Asp is derived from Escherichia coli and is often recognized as a foreign protein. The hypersensitivity induced by L-Asp is of the immediate type in most cases. We report on a 5-year-old girl who was hospitalized for precursor T-cell lymphoblastic leukemia. She was treated according to a Tokyo Children's Cancer Study Group protocol (TCCSG ALL L09-1603 HEX/BFM). During the intensification phase, blisters with erythema developed on the arm proximal to the catheter insertion site owing to a delayed-type hypersensitivity reaction caused by intravenous L-Asp administration. She was treated with additional methylprednisolone, tapered dexamethasone, and an antihistamine for the allergic reaction. No asparaginases other than E. coli L-Asp have been approved for use in Japan. Other asparaginases, such as polyethylene glycol L-Asp and Erwinia L-Asp should be quickly approved for use as alternative chemotherapy reagents in Japan.
authors.affiliation: Department of Pediatrics, Chiba Hokusoh Hospital, Nippon Medical School, Inzai, Chiba, Japan. hide.narazaki@gmail.com
authors.forename: Hidehiko
authors.initials: H
authors.lastname: Narazaki
authors.forename: Kiyohiko
authors.initials: K
authors.lastname: Kaizu
authors.forename: Chiharu
authors.initials: C
authors.lastname: Miyatake
authors.forename: Shinya
authors.initials: S
authors.lastname: Koizumi
authors.forename: Takeshi
authors.initials: T
authors.lastname: Asano
authors.forename: Osamu
authors.initials: O
authors.lastname: Fujino
mesh_terms: D061605:Administration, Intravenous; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000009:adverse effects; D001215:Asparaginase / Q000008:administration & dosage / Q000009:adverse effects*; D002675:Child, Preschool; D003907:Dexamethasone / Q000627:therapeutic use; D004342:Drug Hypersensitivity / Q000209:etiology* / Q000517:prevention & control; D005260:Female; D006633:Histamine Antagonists / Q000627:therapeutic use; D006801:Humans; D006968:Hypersensitivity, Delayed / Q000139:chemically induced* / Q000517:prevention & control; D008775:Methylprednisolone / Q000627:therapeutic use; D054218:Precursor T-Cell Lymphoblastic Leukemia-Lymphoma / Q000188:drug therapy*
chemical_list: D000893:Anti-Inflammatory Agents; D000970:Antineoplastic Agents; D006633:Histamine Antagonists; D003907:Dexamethasone; D001215:Asparaginase; D008775:Methylprednisolone