Allergic reaction to L-asparaginase and treatment outcome of acute lymphoblastic leukemia in children

Akutna limfoblastična leukemija (ALL) najučestalija je zloćudna novotvorina dječje dobi s ukupnim preživljenjem od oko 80%. Bitan napredak u liječenju ALL – a postignut je uvođenjem lijeka l – asparaginaze u polikemoterapijske protokole 1970 – ih godina. Iako ključan za uspjeh liječenja, njegova upotreba ograničena je razvojem neželjenih štetnih učinaka, prvenstveno alergijske reakcije. U ovom retrospektivnom radu ispitivali smo utječe li razvoj alergijske reakcije na l – asparaginazu na ishod liječenja djece s ALL - om. Ispitivana skupina sastojala se od 123 djeteta liječenih po ALL IC – BFM 2002 protokolu. Alergijsku reakciju razvilo je 33,3% djece, koji su nakon toga primali zamjensku terapiju PEG – l –asparaginazom ili Erwinia l – asparaginazom. Nismo dokazali statistički značajnu razliku preživljenja djece s alergijskom reakcijom na l – asparaginazu u odnosu na djecu bez alergijske reakcije. Značajne razlike u preživljenju nije bilo obzirom na skupinu rizika, primjenu zamjenskog lijeka i spol ispitanika. Zbog velike uloge l – asparaginaze u liječenju ALL – a potrebna su daljnja istraživanja sa svrhom boljeg razumijevanja njezinog djelovanja, odabira odgovarajućeg pripravka i doze s najmanje neželjenih štetnih učinaka.Acute lymphoblastic leukemia is the most common malignancy in childhood with overall survival of approximately 80%. An important improvement in ALL treatment was achieved by adding l – asparaginase to multi – agent chemotherapy in 1970s. Although it is essential for successful treatment outcome, its use is limited by toxicity, primarily allergic reaction. In this retrospective study we wanted to determine whether there is a correlation between allergic reaction to l – asparaginase and the outcome of the treatment of children with ALL. Our study included 123 children treated according to ALL IC – BFM 2002 protocol. Allergic reaction occurred in 33,3% children who were later given one of the alternative therapies, either PEG – l – asparaginase or Erwinia l – asparaginase. There was no statistically significant survival difference between the children who developed allergic reaction to l – asparaginase and those who did not. There was no significant difference when it comes to risk group, alternative therapy and gender. Considering its essential role in the treatment of ALL further research is needed, especially in the areas of mechanism of action, selection of appropriate preparation and dosing schedule with the least amount of toxicity